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. 2023 Feb 20:10:1093363.
doi: 10.3389/fcvm.2023.1093363. eCollection 2023.

Infective endocarditis: Do we have an effective risk score model? A systematic review

Victoria Rizzo  1 , Mohammad Yousuf Salmasi  2 , Michael Sabetai  1 , Christopher Primus  3 , Jonathan Sandoe  4 , Michael Lewis  5 , Simon Woldman  3 , Thanos Athanasiou  2
Affiliations

Infective endocarditis: Do we have an effective risk score model? A systematic review

Victoria Rizzo et al. Front Cardiovasc Med. .

Abstract

Background: Infective endocarditis (IE) is a rare, highly morbid condition with 17% in-hospital mortality. A total of 25-30% require surgery and there is ongoing debate with regard to markers predicting patient outcomes and guiding intervention. This systematic review aims to evaluate all IE risk scores currently available.

Methods: Standard methodology (PRISMA guideline) was used. Papers with risk score analysis for IE patients were included, with attention to studies reporting area under the receiver-operating characteristic curve (AUC/ROC). Qualitative analysis was carried out, including assessment of validation processes and comparison of these results to original derivation cohorts where available. Risk-of-bias analysis illustrated according to PROBAST guidelines.

Results: Of 75 articles initially identified, 32 papers were analyzed for a total of 20 proposed scores (range 66-13,000 patients), 14 of which were specific for IE. The number of variables per score ranged from 3 to 14 with only 50% including microbiological variables and 15% including biomarkers. The following scores had good performance (AUC > 0.8) in studies proposing the score (often the derivation cohort); however fared poorly when applied to a new cohort: PALSUSE, DeFeo, ANCLA, RISK-E, EndoSCORE, MELD-XI, COSTA, and SHARPEN. DeFeo score demonstrated the largest discrepancy with initial AUC of 0.88, compared to 0.58 when applied to different cohorts. The inflammatory response in IE has been well documented and CRP has been found to be an independent predictor for worse outcomes. There is ongoing investigation on alternate inflammatory biomarkers which may assist in IE management. Of the scores identified in this review, only three have included a biomarker as a predictor.

Conclusion: Despite the variety of available scores, their development has been limited by small sample size, retrospective collection of data and short-term outcomes, with lack of external validation, limiting their transportability. Future population studies and large comprehensive registries are required to address this unmet clinical need.

Keywords: cardiac surgery; endocarditis; outcome assessment; risk factors; risk score.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Key components for an Infective Endocarditis Risk Score.
FIGURE 2
FIGURE 2
Inclusion of key criteria in IE-specific risk scores currently available.
See this image and copyright information in PMC

References

    1. Quan T, Muller-Pebody B, Fawcett N, Fawcett N, Young B, Minaji M, et al. Investigation of the impact of the NICE guidelines regarding antibiotic prophylaxis during invasive dental procedures on the incidence of infective endocarditis in England: an electronic health records study. BMC Med. (2020) 18:84. 10.1186/s12916-020-01531-y - DOI - PMC - PubMed
    1. Habib G, Erba P, Lung B, Donal E, Cosyns B, Laroche C, et al. Clinical presentation, aetiology and outcome of infective endocarditis. results of the ESC-EORP EURO-ENDO (European IE) registry: a prospective cohort study. Eur Heart J. (2019) 40:3222–32. - PubMed
    1. Gatti G, Perrotti A, Obadia J, Duval X, Iung B, Alla F, et al. Simple Scoring System to predict in-hospital mortality after surgery for infective endocarditis. J Am Heart Assoc. (2017) 6:e004806. - PMC - PubMed
    1. Beynon R, Bahl V, Prendergast B. Infective endocarditis. BMJ. (2006) 333:334. - PMC - PubMed
    1. Habib G, Lancellotti P, Antunes M, Bongiorni M, Casalta J, Del Zotti F, et al. 2015 ESC Guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology(ESC). endorsed by: European Association for Cardio-Thoracic Surgery(EACTS), the European Association of Nuclear Medicine(EANM). Eur Heart J. (2015) 36:3075–128. 10.1093/eurheartj/ehv319 - DOI - PubMed

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