Risk prediction in infective endocarditis by modified MELD-XI score

  • Peng-cheng He
  • Xue-biao Wei
  • Si-ni Luo
  • Xiao-lan Chen
  • Zu-hui Ke
  • Dan-qing Yu
  • Ji-yan Chen
  • Yuan-hui LiuEmail author
  • Ning TanEmail author
Original Article


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.


Infective endocarditis Risk score Prognosis 



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

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

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

Informed consent

Written informed consent was obtained.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Peng-cheng He
    • 1
    • 2
  • Xue-biao Wei
    • 1
  • Si-ni Luo
    • 1
  • Xiao-lan Chen
    • 1
  • Zu-hui Ke
    • 1
  • Dan-qing Yu
    • 1
  • Ji-yan Chen
    • 1
  • Yuan-hui Liu
    • 1
    Email author
  • Ning Tan
    • 1
    Email author
  1. 1.Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease PreventionGuangdong General Hospital, Guangdong Academic of Medical SciencesGuangzhouChina
  2. 2.Department of Cardiology, The Second People’s Hospital of Nanhai DistrictGuangdong General Hospital’s Nanhai HospitalFoshanChina

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