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Infective Endocarditis (IE) Mortality Risk Score

Calculators  Cardiovascular
It predicts mortality at 6 months in patients with infective endocarditis.
Age (in years)
≤45 0
46-60 2
61-70 3
>70 4
History of dialysis
No 0
Yes 3
Nosocomial IE
No 0
Yes 2
Prosthetic IE
No 0
Yes 1
Symptoms >1 month before admission
No 0
Yes -1
Staphylococcus aureus
No 0
Yes 1
Viridans group streptococci
No 0
Yes -2
Aortic vegetation
No 0
Yes 1
Mitral vegetation
No 0
Yes 1
NYHA class 3 or 4 heart failure
No 0
Yes 3
Stroke
No 0
Yes 2
Paravalvular complication
No 0
Yes 2
Persistent bacteremia
No 0
Yes 2
Surgical treatment
No 0
Yes -2
Result:

Background

Measured Factor
Infective endocarditis score
Measured Factor Disease
  • Infective endocarditis
Measured Factor Detail
Infective endocarditis score helps to predict the mortality rate in patients with IE. Several factors are taken into considerations for calculating IE score divided into host factor,IE factor and IE complications. Host factor includes age and history of dialysis while IE factor consists of various types of  IE and infectious strains of bacteria. Complications includes other diseases like stroke,heart failure paravalvular complication and surgical treatment
Speciality
Cardiologist
Body System
Cardiovascular
Formula
Probability of 6‐month mortality = 2.416*score + 0.109*score2 − 4.849
Measured Factor Low Impact
  • A score of 0 indicates that the chances of mortality are 6.6% at 6 months.
Measured Factor High Impact
  • A score of 22 indicates about 94% mortality at 6 months.

Result Interpretation

Ranges Ranges
  • Critical High: 2200%
Result High Conditions
  • Mortality
Test Limitations
The presence of abscesses and large intracardiac destruction are not included in this score
References: 2

Studies

Study Validation 1
The aim of this study is to develop and validate a model of clinical characteristics to predict 6-month mortality in IE. In the derivation model, variables related to host factors such as age, dialysis, IE characteristics including prosthetic or nosocomial IE, causative organism, left-sided valve vegetation, and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were associated independently 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, with a similar, independent benefit of surgery (hazard ratio 0.74, 95% CI 0.62-0.89). A simplified risk model was developed by the weight adjustment of these variables. In conclusion, 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 it is performed less frequently in the highest risk patients.
References: 1
Study Validation 2
The study aims at developing and validating a calculator to predict the risk of in-hospital mortality in patients with active infective endocarditis (IE) undergoing cardiac surgery. Variables included in the final model were age, prosthetic infection, periannular complications, fungi infection, acute renal failure, septic shock, cardiogenic shock and thrombocytopenia. Area under the receiver operating characteristic curve in the validation sample was 0.82 i.e. 95% CI 0.75 to 0.88. The accuracy of the other surgical scores when compared with the RISK-E was shown to be inferior (p=0.010), the score also obtained a good predictive performance, area under the curve 0.76 (95% CI 0.64 to 0.88), in the external validation. In conclusion, IE-specific factors include microorganisms, periannular complications and sepsis beside classical variables in heart surgery (age, haemodynamic condition and renal failure) independently predicted perioperative mortality in IE(infective endocarditis). The RISK-E(Risk-Endocarditis Score) had better ability to predict surgical mortality in patients with IE when compared with other surgical scores.
References: 3
Study Validation 3
The purpose of the study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. A total of 361 consecutive patients (mean age, 59.1±15.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. Score validation procedures were carried out and it is shown that Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate <50 mL/min (OR, 3.52; P<0.0001), New York Heart Association class IV (OR, 2.11; P=0.024), systolic pulmonary artery pressure >55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (AUC, 0.780; 95% CI, 0.734-0.822). In conclusion, a simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE(infective endocarditis).
References: 4
Study Additional 1
Assessment of the prognostic utility of risk scores in surgery for infective endocarditis (IE) was done to evaluate their reliability in mortality risk prediction with a total of 180 patients. In this, the discrimination was evaluated using the area under the receiver operating characteristic curve. The STS-IE score had higher discrimination when compared with the De Feo-Cotrufo score with P = 0.055 and the Costa score with P = 0.024; however, there was no significant difference when the comparison was done of the STS-IE score with the PALSUSE score (P = 0.58). Calibration was assessed using the Hosmer-Lemeshow test; an adequate calibration was confirmed in all 4 scores. The STS-IE score had the highest discrimination and was suitably calibrated.
References: 2
Study Additional 2
The main objective of this study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE(infective endocarditis) and to create a mortality risk score based on the results of this analysis. Out of 138 consecutive patients, Twenty-eight (20.3%) patients died in hospital following surgery. New York Heart Association class IV (OR 2.61, p = 0.09), Anemia [odds ratio (OR) 11.0, p = 0.035), critical state (OR 4.97, p = 0.016), large intracardiac destruction (OR 6.45, p = 0.0014), and surgery of the thoracic aorta (OR 7.51, p = 0.041) were independent predictors of hospital death. In conclusion, it can be said that a simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk after surgery for IE.
References: 5

References

  1. Park LP, Chu VH, Peterson G, Skoutelis A, Lejko-Zupa T, Bouza E, et al. Validated Risk Score for Predicting 6-Month Mortality in Infective Endocarditis. J Am Heart Assoc. 2016;5(4):e003016.
  2. Varela L, López-menéndez J, Redondo A, Fajardo ER, Miguelena J, Centella T, et al. Mortality risk prediction in infective endocarditis surgery: reliability analysis of specific scores. Eur J Cardiothorac Surg. 2018;53(5):1049-1054.
  3. Olmos C, Vilacosta I, Habib G, Maroto L, Fernández C, López J, et al. Risk score for cardiac surgery in active left-sided infective endocarditis. Heart. 2017;103(18):1435-1442.
  4. Gatti G, Perrotti A, Obadia JF, 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(7)
  5. Gatti G, Benussi B, Gripshi F, Della Mattia A, Proclemer A, Cannatà A, et al. A risk factor analysis for in-hospital mortality after surgery for infective endocarditis and a proposal of a new predictive scoring system. Infection. 2017;45(4):413-423.