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Risk prediction in infective endocarditis by modified MELD-XI score

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Abstract

The suitability of the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score to predict adverse outcomes in infective endocarditis (IE) patients remains uncertain. This study was performed to explore the prognostic value of the MELD-XI score and modified MELD-XI score for patients with IE. A total of 858 patients with IE were consecutively enrolled and classified into two groups: MELD-XI ≤ 10 (n = 588) and MELD-XI > 10 (n = 270). Multivariate analysis was performed to determine risk factors independent of MELD-XI score. Higher MELD-XI score was associated with higher in-hospital mortality (15.6 vs. 4.8%, p < 0.001) and major adverse clinical events (33.3 vs. 18.4%, p < 0.001). MELD-XI score was an independent predictor of in-hospital death (odds ratio [OR] = 1.06, 95% CI, 1.02–1.10, p = 0.005). Based on a multivariate analysis, NYHA class III or IV (3 points), C-reactive protein > 9.5 mg/L (4 points), and non-surgical treatment (6 points) were added to MELD-XI score. Modified MELD-XI score produced higher predictive power than previous (AUC 0.823 vs. 0.701, p < 0.001). The cumulative incidence of long-term mortality (median 29 months) was significantly higher in patients with modified MELD-XI score > 13 than those without (log-rank = 25.30, p < 0.001). Modified MELD-XI score was independently associated with long-term mortality (hazard ratio = 1.08, 95% CI, 1.04–1.12, p < 0.001). MELD-XI score could be used as a risk assessment tool in IE. Furthermore, modified MELD-XI score remained simple and more effective in predicting poor prognosis.

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References

  1. Cahill TJ, Baddour LM, Habib G, Hoen B, Salaun E, Pettersson GB, Schafers HJ, Prendergast BD (2017) Challenges in infective endocarditis. J Am Coll Cardiol 69:325–344

    Article  PubMed  Google Scholar 

  2. Thuny F, Grisoli D, Collart F, Habib G, Raoult D (2012) Management of infective endocarditis: challenges and perspectives. Lancet 379:965–975

    Article  PubMed  Google Scholar 

  3. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del ZF, Dulgheru R, El KG, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos MP, Vilacosta I, Zamorano JL, Erol C, Nihoyannopoulos P, Aboyans V, Agewall S, Athanassopoulos G, Aytekin S, Benzer W, Bueno H, Broekhuizen L, Carerj S, Cosyns B, De Backer J, De Bonis M, Dimopoulos K, Donal E, Drexel H, Flachskampf FA, Hall R, Halvorsen S, Hoen B, Kirchhof P, Lainscak M, Leite-Moreira AF, Lip GY, Mestres CA, Piepoli MF, Punjabi PP, Rapezzi C, Rosenhek R, Siebens K, Tamargo J, Walker DM (2015) 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 36:3075–3128

    Article  PubMed  Google Scholar 

  4. Park LP, Chu VH, Peterson G, Skoutelis A, Lejko-Zupa T, Bouza E, Tattevin P, Habib G, Tan R, Gonzalez J, Altclas J, Edathodu J, Fortes CQ, Siciliano RF, Pachirat O, Kanj S, Wang A (2016) Validated risk score for predicting 6-month mortality in infective endocarditis. J Am Heart Assoc 5:e3016

    Article  Google Scholar 

  5. Chu VH, Park LP, Athan E, Delahaye F, Freiberger T, Lamas C, Miro JM, Mudrick DW, Strahilevitz J, Tribouilloy C, Durante-Mangoni E, Pericas JM, Fernandez-Hidalgo N, Nacinovich F, Rizk H, Krajinovic V, Giannitsioti E, Hurley JP, Hannan MM, Wang A (2015) Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the international collaboration on endocarditis. Circulation 131:131–140

    Article  PubMed  Google Scholar 

  6. Gaca JG, Sheng S, Daneshmand MA, O'Brien S, Rankin JS, Brennan JM, Hughes GC, Glower DD, Gammie JS, Smith PK (2011) Outcomes for endocarditis surgery in North America: a simplified risk scoring system. J Thorac Cardiovasc Surg 141:98–106

    Article  PubMed  Google Scholar 

  7. Martinez-Selles M, Munoz P, Arnaiz A, Moreno M, Galvez J, Rodriguez-Roda J, de Alarcon A, Garcia CE, Farinas MC, Miro JM, Montejo M, Moreno A, Ruiz-Morales J, Goenaga MA, Bouza E (2014) Valve surgery in active infective endocarditis: a simple score to predict in-hospital prognosis. Int J Cardiol 175:133–137

    Article  PubMed  Google Scholar 

  8. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D'Amico G, Dickson ER, Kim WR (2001) A model to predict survival in patients with end-stage liver disease. Hepatology 33:464–470

    Article  PubMed  CAS  Google Scholar 

  9. Inohara T, Kohsaka S, Shiraishi Y, Goda A, Sawano M, Yagawa M, Mahara K, Fukuda K, Yoshikawa T (2014) Prognostic impact of renal and hepatic dysfunction based on the MELD-XI score in patients with acute heart failure. Int J Cardiol 176:571–573

    Article  PubMed  Google Scholar 

  10. Kim MS, Kato TS, Farr M, Wu C, Givens RC, Collado E, Mancini DM, Schulze PC (2013) Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction. J Am Coll Cardiol 61:2253–2261

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sheerin NJ, Newton PJ, Macdonald PS, Leung DY, Sibbritt D, Spicer ST, Johnson K, Krum H, Davidson PM (2014) Worsening renal function in heart failure: the need for a consensus definition. Int J Cardiol 174:484–491

    Article  PubMed  Google Scholar 

  12. Braam B, Joles JA, Danishwar AH, Gaillard CA (2014) Cardiorenal syndrome—current understanding and future perspectives. Nat Rev Nephrol 10:48–55

    Article  PubMed  CAS  Google Scholar 

  13. Forman DE, Butler J, Wang Y, Abraham WT, O'Connor CM, Gottlieb SS, Loh E, Massie BM, Rich MW, Stevenson LW, Young JB, Krumholz HM (2004) Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol 43:61–67

    Article  PubMed  Google Scholar 

  14. Samsky MD, Patel CB, DeWald TA, Smith AD, Felker GM, Rogers JG, Hernandez AF (2013) Cardiohepatic interactions in heart failure: An overview and clinical implications. J Am Coll Cardiol 61:2397–2405

    Article  PubMed  Google Scholar 

  15. Poelzl G, Ess M, Mussner-Seeber C, Pachinger O, Frick M, Ulmer H (2012) Liver dysfunction in chronic heart failure: prevalence, characteristics and prognostic significance. Eur J Clin Investig 42:153–163

    Article  CAS  Google Scholar 

  16. Chand N, Sanyal AJ (2007) Sepsis-induced cholestasis. Hepatology 45:230–241

    Article  PubMed  CAS  Google Scholar 

  17. Yamano S, Shimizu K, Ogura H, Hirose T, Hamasaki T, Shimazu T, Tasaki O (2016) Low total cholesterol and high total bilirubin are associated with prognosis in patients with prolonged sepsis. J Crit Care 31:36–40

    Article  PubMed  CAS  Google Scholar 

  18. Pepys MB, Hirschfield GM (2003) C-reactive protein: a critical update. J Clin Invest 111:1805–1812

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Heiro M, Helenius H, Sundell J, Koskinen P, Engblom E, Nikoskelainen J, Kotilainen P (2005) Utility of serum C-reactive protein in assessing the outcome of infective endocarditis. Eur Heart J 26:1873–1881

    Article  PubMed  CAS  Google Scholar 

  20. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VJ, Ryan T, Bashore T, Corey GR (2000) Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30:633–638

    Article  PubMed  CAS  Google Scholar 

  21. Chu VH, Cabell CH, Benjamin DJ, Kuniholm EF, Fowler VJ, Engemann J, Sexton DJ, Corey GR, Wang A (2004) Early predictors of in-hospital death in infective endocarditis. Circulation 109:1745–1749

    Article  PubMed  Google Scholar 

  22. Mirabel M, Sonneville R, Hajage D, Novy E, Tubach F, Vignon P, Perez P, Lavoue S, Kouatchet A, Pajot O, Mekontso-Dessap A, Tonnelier JM, Bollaert PE, Frat JP, Navellou JC, Hyvernat H, Hssain AA, Timsit JF, Megarbane B, Wolff M, Trouillet JL (2014) Long-term outcomes and cardiac surgery in critically ill patients with infective endocarditis. Eur Heart J 35:1195–1204

    Article  PubMed  Google Scholar 

  23. Fernandez-Hidalgo N, Almirante B, Tornos P, Gonzalez-Alujas MT, Planes AM, Larrosa MN, Sambola A, Igual A, Pahissa A (2011) Prognosis of left-sided infective endocarditis in patients transferred to a tertiary-care hospital—prospective analysis of referral bias and influence of inadequate antimicrobial treatment. Clin Microbiol Infect 17:769–775

    Article  PubMed  CAS  Google Scholar 

  24. Olmos C, Vilacosta I, Habib G, Maroto L, Fernández C, López J, Sarriá C, Salaun E, Di Stefano S, Carnero M, Hubert S, Ferrera C, Tirado G, Freitas-Ferraz A, Sáez C, Cobiella J, Bustamante-Munguira J, Sánchez-Enrique C, García-Granja PE, Lavoute C, Obadia B, Vivas D, Gutiérrez Á, San Román JA (2017) Risk score for cardiac surgery in active left-sided infective endocarditis. Heart 103:1435–1442

    Article  PubMed  Google Scholar 

  25. Heuman DM, Mihas AA, Habib A, Gilles HS, Stravitz RT, Sanyal AJ, Fisher RA (2007) MELD-XI: a rational approach to “sickest first” liver transplantation in cirrhotic patients requiring anticoagulant therapy. Liver Transpl 13:30–37

    Article  PubMed  Google Scholar 

  26. Damman K, Valente MA, Voors AA, O’Connor CM, van Veldhuisen DJ, Hillege HL (2014) Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J 35:455–469

    Article  PubMed  Google Scholar 

  27. Tamura K, Arai H, Yoshizaki T (2012) Long-term outcome of active infective endocarditis with renal insufficiency in cardiac surgery. Ann Thorac Cardiovasc Surg 18:216–221

    Article  PubMed  Google Scholar 

  28. Cogger VC, Fraser R, Le Couteur DG (2003) Liver dysfunction and heart failure. Am J Cardiol 91:1399

    Article  PubMed  Google Scholar 

  29. Ambrosy AP, Vaduganathan M, Huffman MD, Khan S, Kwasny MJ, Fought AJ, Maggioni AP, Swedberg K, Konstam MA, Zannad F, Gheorghiade M (2012) Clinical course and predictive value of liver function tests in patients hospitalized for worsening heart failure with reduced ejection fraction: an analysis of the EVEREST trial. Eur J Heart Fail 14:302–311

    Article  PubMed  CAS  Google Scholar 

  30. Cahill TJ, Prendergast BD (2016) Infective endocarditis. Lancet 387:882–893

    Article  PubMed  Google Scholar 

  31. Whitehead MW, Hainsworth I, Kingham JG (2001) The causes of obvious jaundice in South West Wales: perceptions versus reality. Gut 48:409–413

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  32. Gabay C, Kushner I (1999) Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 340:448–454

    Article  PubMed  CAS  Google Scholar 

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Funding

This study was supported by Science and Technology Projects of Guangdong (grant no. 2017ZC0331).

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Authors and Affiliations

  1. Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, 510080, China

    Peng-cheng He, Xue-biao Wei, Si-ni Luo, Xiao-lan Chen, Zu-hui Ke, Dan-qing Yu, Ji-yan Chen, Yuan-hui Liu & Ning Tan

  2. Department of Cardiology, The Second People’s Hospital of Nanhai District, Guangdong General Hospital’s Nanhai Hospital, Foshan, 528251, China

    Peng-cheng He

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  1. Peng-cheng He
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Correspondence to Yuan-hui Liu or Ning Tan.

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The authors declare that they have no conflicts of interest.

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The present study was conducted in Guangdong general hospital and approved by the hospital ethics committee.

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Written informed consent was obtained.

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Peng-cheng He, Xue-biao Wei, and Si-ni Luo are considered as co-first authors.

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He, Pc., Wei, Xb., Luo, Sn. et al. Risk prediction in infective endocarditis by modified MELD-XI score. Eur J Clin Microbiol Infect Dis 37, 1243–1250 (2018). https://doi.org/10.1007/s10096-018-3240-8

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  • DOI: https://doi.org/10.1007/s10096-018-3240-8

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