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. 2016 Apr 18;5(4):e003016.
doi: 10.1161/JAHA.115.003016.

Validated Risk Score for Predicting 6-Month Mortality in Infective Endocarditis

Lawrence P Park  1 , Vivian H Chu  1 , Gail Peterson  2 , Athanasios Skoutelis  3 , Tatjana Lejko-Zupa  4 , Emilio Bouza  5 , Pierre Tattevin  6 , Gilbert Habib  7 , Ren Tan  8 , Javier Gonzalez  9 , Javier Altclas  10 , Jameela Edathodu  11 , Claudio Querido Fortes  12 , Rinaldo Focaccia Siciliano  13 , Orathai Pachirat  14 , Souha Kanj  15 , Andrew Wang  16 ; International Collaboration on Endocarditis (ICE) Investigators
Collaborators, Affiliations

Validated Risk Score for Predicting 6-Month Mortality in Infective Endocarditis

Lawrence P Park et al. J Am Heart Assoc. .

Abstract

Background: Host factors and complications have been associated with higher mortality in infective endocarditis (IE). We sought to develop and validate a model of clinical characteristics to predict 6-month mortality in IE.

Methods and results: Using a large multinational prospective registry of definite IE (International Collaboration on Endocarditis [ICE]-Prospective Cohort Study [PCS], 2000-2006, n=4049), a model to predict 6-month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method. This model was externally validated in an independent prospective registry (ICE-PLUS, 2008-2012, n=1197). The 6-month mortality was 971 of 4049 (24.0%) in the ICE-PCS cohort and 342 of 1197 (28.6%) in the ICE-PLUS cohort. Surgery during the index hospitalization was performed in 48.1% and 54.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis), IE characteristics (prosthetic or nosocomial IE, causative organism, left-sided valve vegetation), and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated with 6-month mortality, and surgery was associated with a lower risk of mortality (Harrell's C statistic 0.715). In the validation model, these variables had similar hazard ratios (Harrell's C statistic 0.682), with a similar, independent benefit of surgery (hazard ratio 0.74, 95% CI 0.62-0.89). A simplified risk model was developed by weight adjustment of these variables.

Conclusions: Six-month mortality after IE is ≈25% and is predicted by host factors, IE characteristics, and IE complications. Surgery during the index hospitalization is associated with lower mortality but is performed less frequently in the highest risk patients. A simplified risk model may be used to identify specific risk subgroups in IE.

Keywords: infection; mortality; prognosis; surgery; valves.

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Figures

Figure 1
Figure 1
Kaplan–Meier survival probabilities for the International Collaboration on Endocarditis–Prospective Cohort Study derivation cohort by quintiles of simplified risk score.
Figure 2
Figure 2
Kaplan–Meier survival probabilities for the International Collaboration on Endocarditis–PLUS validation cohort by quintiles of simplified risk score.
Figure 3
Figure 3
Relationships between simplified infective endocarditis risk scores and observed 6‐month mortality in ICE‐PCS derivation cohort and ICE‐PCS validation cohorts. Adjusted R 2=0.91 and R 2=0.97 for ICE‐PCS and ICE‐PLUS cohorts, respectively. ICE indicates International Collaboration on Endocarditis; PCS, Prospective Cohort Study.
Figure 4
Figure 4
Mortality at 6 months by quintiles of simplified risk score in the development and validation cohorts. ICE indicates International Collaboration on Endocarditis; PCS, Prospective Cohort Study.
Figure 5
Figure 5
Receiver operating characteristic analysis for simplified risk score in the International Collaboration on Endocarditis–Prospective Cohort Study derivation cohort.
See this image and copyright information in PMC

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