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ASSESS-IE: a Novel Risk Score for Patients with Infective Endocarditis

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Abstract

Mortality in patients with infective endocarditis (IE) remains high. The existing risk scores are relatively complex with limited clinical application. This study was conducted to establish a new risk model to predict in-hospital and 6-month mortality in IE patients. A total of 1549 adult patients with definite IE admitted to Guangdong Provincial People’s Hospital (n=1354) or Xiamen Cardiovascular Hospital (n=195) were included. The derivation cohort consisted of 1141 patients. The score was developed using the multivariate stepwise logistic regression analysis for in-hospital death. Bootstrap analysis was used for validation. Discrimination and calibration were evaluated by the receiver operating characteristic curve and the Hosmer–Lemeshow goodness-of-fit test. Six risk factors were used as score parameters (1 point for each): aortic valve affected, previous valve replacement surgery, severe heart failure, elevated serum direct bilirubin, moderate–severe anemia and acute stage. The predictive value and calibration of the ASSESS-IE score for in-hospital death were excellent in the derivation (area under the curve [AUC]=0.781, p<0.001; Hosmer–Lemeshow p=0.948) and validation (AUC=0.779, p<0.001; Hosmer–Lemeshow p=0.520) cohorts. The score remained excellent in bootstrap validation (AUC=0.783). The discriminatory ability of the ASSESS-IE score for in-hospital (AUC: 0.781 vs. 0.799, p=0.398) and 6-month mortality (AUC: 0.778 vs. 0.814, p=0.040) were similar with that of Park’s score which comprised 14 variables. The ASSESS-IE risk score is a new and robust risk-stratified tool for patients with IE, which might further facilitate clinical decision-making.

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Data Availability

The data will be shared on reasonable request to the corresponding author.

Abbreviations

IE :

Infective endocarditis

ALT :

Alanine aminotransferase

LVEF :

Left ventricular ejection fraction

PASP :

Pulmonary artery systolic pressure

eGFR :

Estimated glomerular filtration rate

CKD-EPI :

Chronic Kidney Disease Epidemiology Collaboration

NYHA :

New York Heart Association

References

  1. Cahill TJ, Prendergast BD. Infective endocarditis. Lancet. 2016;387(10021):882–93. https://doi.org/10.1016/S0140-6736(15)00067-7.

    Article  PubMed  Google Scholar 

  2. Dayer MJ, Jones S, Prendergast B, Baddour LM, Lockhart PB, Thornhill MH. Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis. Lancet. 2015;385(9974):1219–28. https://doi.org/10.1016/S0140-6736(14)62007-9.

    Article  PubMed  Google Scholar 

  3. Olmos C, Vilacosta I, Fernandez-Perez C, Bernal JL, Ferrera C, Garcia-Arribas D, et al. The evolving nature of infective endocarditis in Spain: a population-based study (2003 to 2014). J Am Coll Cardiol. 2017;70(22):2795–804. https://doi.org/10.1016/j.jacc.2017.10.005.

    Article  PubMed  Google Scholar 

  4. Toyoda N, Chikwe J, Itagaki S, Gelijns AC, Adams DH, Egorova NN. Trends in infective endocarditis in California and New York State, 1998-2013. JAMA. 2017;317(16):1652–60. https://doi.org/10.1001/jama.2017.4287.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Shah ASV, McAllister DA, Gallacher P, Astengo F, Rodriguez Perez JA, Hall J, et al. Incidence, microbiology, and outcomes in patients hospitalized with infective endocarditis. Circulation. 2020;141(25):2067–77. https://doi.org/10.1161/CIRCULATIONAHA.119.044913.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Iung B, Duval X. Infective endocarditis: innovations in the management of an old disease. Nat Rev Cardiol. 2019;16(10):623–35. https://doi.org/10.1038/s41569-019-0215-0.

    Article  PubMed  Google Scholar 

  7. Kumar A, Anstey C, Tesar P, Shekar K. Risk factors for mortality in patients undergoing cardiothoracic surgery for infective endocarditis. Ann Thorac Surg. 2019;108(4):1101–6. https://doi.org/10.1016/j.athoracsur.2019.05.029.

    Article  PubMed  Google Scholar 

  8. Habib G, Erba PA, Iung 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 infective endocarditis) registry: a prospective cohort study. Eur Heart J. 2019;40(39):3222–32. https://doi.org/10.1093/eurheartj/ehz620.

    Article  CAS  PubMed  Google Scholar 

  9. Ren Z, Mo X, Chen H, Peng J. A changing profile of infective endocarditis at a tertiary hospital in China: a retrospective study from 2001 to 2018. BMC Infect Dis. 2019;19(1):945. https://doi.org/10.1186/s12879-019-4609-8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. De Feo M, Cotrufo M, Carozza A, De Santo LS, Amendolara F, Giordano S, et al. The need for a specific risk prediction system in native valve infective endocarditis surgery. Sci World J. 2012;2012:307571. https://doi.org/10.1100/2012/307571.

    Article  Google Scholar 

  11. Gaca JG, Sheng S, Daneshmand MA, O'Brien S, Rankin JS, Brennan JM, et al. Outcomes for endocarditis surgery in North America: a simplified risk scoring system. J Thorac Cardiovasc Surg. 2011;141(1):98–106. https://doi.org/10.1016/j.jtcvs.2010.09.016.

    Article  PubMed  Google Scholar 

  12. Chee QZ, Tan YQ, Ngiam JN, Win MT, Shen X, Choo JN, et al. The SHARPEN clinical risk score predicts mortality in patients with infective endocarditis: an 11-year study. Int J Cardiol. 2015;191:273–6. https://doi.org/10.1016/j.ijcard.2015.04.236.

    Article  PubMed  Google Scholar 

  13. 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. https://doi.org/10.1161/JAHA.115.003016.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, 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(44):3075–128. https://doi.org/10.1093/eurheartj/ehv319.

    Article  PubMed  Google Scholar 

  15. Varela L, Lopez-Menendez 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):1049–54. https://doi.org/10.1093/ejcts/ezx428.

    Article  PubMed  Google Scholar 

  16. Rizzo V, Salmasi MY, Sabetai M, Primus C, Sandoe J, Lewis M, Woldman S, Athanasiou T. Infective endocarditis: do we have an effective risk score model? A systematic review. Front Cardiovasc Med. 2023;10:1093363. https://doi.org/10.3389/fcvm.2023.1093363.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hurrell H, Roberts-Thomson R, Prendergast BD. Non-infective endocarditis. Heart. 2020;106(13):1023–9. https://doi.org/10.1136/heartjnl-2019-315204.

    Article  CAS  PubMed  Google Scholar 

  18. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30(4):633–8. https://doi.org/10.1086/313753.

    Article  CAS  PubMed  Google Scholar 

  19. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685–713. https://doi.org/10.1016/j.echo.2010.05.010.

    Article  PubMed  Google Scholar 

  20. Garcia-Granja PE, Lopez J, Vilacosta I, Sarria C, Dominguez F, Ladron R, et al. Predictive model of in-hospital mortality in left-sided infective endocarditis. Rev Esp Cardiol (Engl Ed). 2020;73(11):902–9. https://doi.org/10.1016/j.rec.2019.11.003.

    Article  PubMed  Google Scholar 

  21. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12. https://doi.org/10.7326/0003-4819-150-9-200905050-00006.

    Article  PubMed  PubMed Central  Google Scholar 

  22. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837–45.

    Article  CAS  PubMed  Google Scholar 

  23. Chu VH, Park LP, Athan E, Delahaye F, Freiberger T, Lamas C, et al. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis. Circulation. 2015;131(2):131–40. https://doi.org/10.1161/CIRCULATIONAHA.114.012461.

    Article  PubMed  Google Scholar 

  24. Costa MA, Wollmann DR Jr, Campos AC, Cunha CL, Carvalho RG, Andrade DF, et al. Risk index for death by infective endocarditis: a multivariate logistic model. Rev Bras Cir Cardiovasc. 2007;22(2):192–200. https://doi.org/10.1590/s0102-76382007000200007.

    Article  PubMed  Google Scholar 

  25. Martinez-Selles M, Munoz P, Arnaiz A, Moreno M, Galvez J, Rodriguez-Roda J, et al. Valve surgery in active infective endocarditis: a simple score to predict in-hospital prognosis. Int J Cardiol. 2014;175(1):133–7. https://doi.org/10.1016/j.ijcard.2014.04.266.

    Article  PubMed  Google Scholar 

  26. Di Mauro M, Dato GMA, Barili F, Gelsomino S, Sante P, Corte AD, et al. A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE. Int J Cardiol. 2017;241:97–102. https://doi.org/10.1016/j.ijcard.2017.03.148.

    Article  PubMed  Google Scholar 

  27. Olmos C, Vilacosta I, Habib G, Maroto L, Fernandez C, Lopez J, et al. Risk score for cardiac surgery in active left-sided infective endocarditis. Heart. 2017;103(18):1435–42. https://doi.org/10.1136/heartjnl-2016-311093.

    Article  PubMed  Google Scholar 

  28. 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) https://doi.org/10.1161/JAHA.116.004806.

  29. Gatti G, Benussi B, Gripshi F, Della Mattia A, Proclemer A, Cannata 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):413–23. https://doi.org/10.1007/s15010-016-0977-9.

    Article  PubMed  Google Scholar 

  30. Varela Barca L, Fernandez-Felix BM, Navas Elorza E, Mestres CA, Munoz P, Cuerpo-Caballero G, et al. Prognostic assessment of valvular surgery in active infective endocarditis: multicentric nationwide validation of a new score developed from a meta-analysis. Eur J Cardiothorac Surg. 2020;57(4):724–31. https://doi.org/10.1093/ejcts/ezz328.

    Article  PubMed  Google Scholar 

  31. Gatti G, Sponga S, Peghin M, Givone F, Ferrara V, Benussi B, et al. Risk scores and surgery for infective endocarditis: in search of a good predictive score. Scand Cardiovasc J. 2019;53(3):117–24. https://doi.org/10.1080/14017431.2019.1610188.

    Article  PubMed  Google Scholar 

  32. Wang A, Gaca JG, Chu VH. Management considerations in infective endocarditis: a review. JAMA. 2018;320(1):72–83. https://doi.org/10.1001/jama.2018.7596.

    Article  PubMed  Google Scholar 

  33. El Hadi H, Di Vincenzo A, Vettor R, Rossato M. Relationship between heart disease and liver disease: a two-way street. Cells. 2020;9(3). https://doi.org/10.3390/cells9030567.

  34. Xanthopoulos A, Starling RC, Kitai T, Triposkiadis F. Heart failure and liver disease: cardiohepatic interactions. JACC Heart Fail. 2019;7(2):87–97. https://doi.org/10.1016/j.jchf.2018.10.007.

    Article  PubMed  Google Scholar 

  35. Delemos AS, Friedman LS. Systemic causes of cholestasis. Clin Liver Dis. 2013;17(2):301–17. https://doi.org/10.1016/j.cld.2012.11.001.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Cuervo G, Escrihuela-Vidal F, Gudiol C, Carratala J. Current challenges in the management of infective endocarditis. Front Med (Lausanne). 2021;8:641243. https://doi.org/10.3389/fmed.2021.641243.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Wei XB, Wang Y, Liu YH, Huang JL, Yu DQ, Chen JY. Effect of conjugated bilirubin on clinical outcomes in infective endocarditis. Eur J Clin Microbiol Infect Dis. 2019;38(12):2259–66. https://doi.org/10.1007/s10096-019-03670-4.

    Article  CAS  PubMed  Google Scholar 

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Funding

This study was supported by grants from the National Natural Science Foundation of China (Grant No. 82002014), Natural Science Foundation of Guangdong Province (grant no. 2021A1515010107), Project of Administration of Traditional Chinese Medicine of Guangdong Province of China (Grant No. 20221003), Science and Technology Projects of Guangzhou (Grant No. 201903010097), and Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention (Grant No. Y0120220151). The funders had no role in the study design, data collection and analysis, decision to publish, nor preparation of the manuscript.

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Authors and Affiliations

  1. Division of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China

    Xuebiao Wei, Zhonghua Wang & Shouhong Wang

  2. Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China

    Peng Ran, Yuxin Nong, Younan Yao, Junqing Yang, Danqing Yu & Jiyan Chen

  3. Division of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, Xiamen, 361004, China

    Tao Ye, Yiwei Xu & Yang Li

  4. Division of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China

    Xuhua Jian

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  1. Xuebiao Wei
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  2. Peng Ran
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Contributions

JC, DY, and SW were involved in the conception and design of this study. XW, PR, YN, BF, TY, XJ, HG, YX, YL, ZW, and JY contributed to data collection and data interpretation. XW, PR, and YN constructed the manuscript, which was revised and approved by all the authors for publication.

Corresponding authors

Correspondence to Shouhong Wang, Danqing Yu or Jiyan Chen.

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Ethical Approval

This study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committee of Guangdong Provincial People’s Hospital (NO. GDREC2020098)

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The authors declare no competing interests.

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Associate Editor Rupak Mukherjee oversaw the review of this article

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Xuebiao Wei, Peng Ran and, Yuxin Nong are considered as co-first authors.

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Wei, X., Ran, P., Nong, Y. et al. ASSESS-IE: a Novel Risk Score for Patients with Infective Endocarditis. J. of Cardiovasc. Trans. Res. (2023). https://doi.org/10.1007/s12265-023-10456-9

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