Validated Risk Score for Predicting 6‐Month Mortality in Infective Endocarditis
Authors: Park Lawrence P. , Chu Vivian H. , Peterson Gail , Skoutelis Athanasios , Lejko‐Zupa Tatjana , Bouza Emilio , Tattevin Pierre , Habib Gilbert , Tan Ren , Gonzalez Javier , Altclas Javier , Edathodu Jameela , Fortes Claudio Querido , Siciliano Rinaldo Focaccia , Pachirat Orathai , Kanj Souha , Wang Andrew , Clara Liliana , Sanchez Marisa , Casabé José , Cortes Claudia , Nacinovich Francisco , Fernandez Oses Pablo , Ronderos Ricardo , Sucari Adriana , Thierer Jorge , Kogan Silvia , Spelman Denis , Athan Eugene , Harris Owen , Kennedy Karina , Gordon David , Papanicolas Lito , Korman Tony , Kotsanas Despina , Dever Robyn , Jones Phillip , Konecny Pam , Lawrence Richard , Rees David , Ryan Suzanne , Feneley Michael P. , Harkness John , Jones Phillip , Ryan Suzanne , Jones Phillip , Ryan Suzanne , Jones Phillip , Post Jeffrey , Reinbott Porl , Ryan Suzanne , Gattringer Rainer , Wiesbauer Franz , Andrade Adriana Ribas , de Brito Ana Cláudia Passos , Guimarães Armenio Costa , Grinberg Max , Mansur Alfredo José , Strabelli Tania Mara Varejao , Vieira Marcelo Luiz Campos , de Medeiros Tranchesi Regina Aparecida , Paiva Marcelo Goulart , de Oliveira Ramos Auristela , Weksler Clara , Ferraiuoli Giovanna , Golebiovski Wilma , Lamas Cristiane , Karlowsky James A. , Keynan Yoav , Morris Andrew M. , Rubinstein Ethan , Jones Sandra Braun , Garcia Patricia , Fica Alberto , Mella Rodrigo Montagna , Fernandez Ricardo , Franco Liliana , Jaramillo Astrid Natalia , Barsic Bruno , Bukovski Suzana , Krajinovic Vladimir , Pangercic Ana , Rudez Igor , Vincelj Josip , Freiberger Tomas , Pol Jiri , Zaloudikova Barbora , Ashour Zainab , El Kholy Amani , Mishaal Marwa , Osama Dina , Rizk Hussien , Aissa Neijla , Alauzet Corentine , Alla Francois , Campagnac Catherine , Doco‐Lecompte Thanh , Selton‐Suty Christine , Casalta Jean‐Paul , Fournier Pierre‐Edouard , Raoult Didier , Thuny Franck , Delahaye Francois , Delahaye Armelle , Vandenesch Francois , Donal Erwan , Donnio Pierre Yves , Flecher Erwan , Michelet Christian , Revest Matthieu , Chevalier Florent , Jeu Antoine , Rémadi Jean Paul , Rusinaru Dan , Tribouilloy Christophe , Bernard Yvette , Chirouze Catherine , Hoen Bruno , Leroy Joel , Plesiat Patrick , Naber Christoph , Neuerburg Carl , Mazaheri Bahram , Naber Christoph , Neuerburg Carl , Athanasia Sophia , Deliolanis Ioannis , Giamarellou Helen , Thomas Tsaganos , Giannitsioti Efthymia , Mylona Elena , Paniara Olga , Papanicolaou Konstantinos , Pyros John , Mylona Elena , Paniara Olga , Papanikolaou Konstantinos , Pyros John , Sharma Gautam , Francis Johnson , Nair Lathi , Thomas Vinod , Venugopal Krishnan , Hannan Margaret M. , Hurley John P. , Cahan Amos , Gilon Dan , Israel Sarah , Korem Maya , Strahilevitz Jacob , Rubinstein Ethan , Strahilevitz Jacob , Durante‐Mangoni Emanuele , Mattucci Irene , Pinto Daniela , Agrusta Federica , Senese Alessandra , Ragone Enrico , Utili Riccardo , Cecchi Enrico , De Rosa Francesco , Forno Davide , Imazio Massimo , Trinchero Rita , Grossi Paolo , Lattanzio Mariangela , Toniolo Antonio , Goglio Antonio , Raglio Annibale , Ravasio Veronica , Rizzi Marco , Suter Fredy , Carosi Giampiero , Magri Silvia , Signorini Liana , Kanafani Zeina , Kanj Souha S. , Sharif‐Yakan Ahmad , Abidin Imran , Tamin Syahidah Syed , Martínez Eduardo Rivera , Soto Nieto Gabriel Israel , van der Meer Jan T.M. , Chambers Stephen , Holland David , Morris Arthur , Raymond Nigel , Read Kerry , Murdoch David R. , Dragulescu Stefan , Ionac Adina , Mornos Cristian , Butkevich O.M. , Chipigina Natalia , Kirill Ozerecky , Vadim Kulichenko , Vinogradova Tatiana , Halim Magid , Liew Yee‐Yun , Tan Ru‐San , Logar Mateja , Mueller‐Premru Manica , Commerford Patrick , Commerford Anita , Deetlefs Eduan , Hansa Cass , Ntsekhe Mpiko , Almela Manuel , Armero Yolanda , Azqueta Manuel , Castañeda Ximena , Cervera Carlos , Falces Carlos , Garcia‐de‐la‐Maria Cristina , Fita Guillermina , Gatell Jose M. , Heras Magda , Llopis Jaime , Marco Francesc , Mestres Carlos A. , Miró José M. , Moreno Asuncion , Ninot Salvador , Paré Carlos , Pericas Juan M. , Ramirez Jose , Rovira Irene , Sitges Marta , Anguera Ignasi , Font Bernat , Guma Joan Raimon , Bermejo Javier , Garcia Fernández Miguel Angel , Gonzalez‐Ramallo Victor , Marín Mercedes , Muñoz Patricia , Pedromingo Miguel , Roda Jorge , Rodríguez‐Créixems Marta , Solis Jorge , Almirante Benito , Fernandez‐Hidalgo Nuria , Tornos Pilar , de Alarcón Arístides , Parra Ricardo , Alestig Eric , Johansson Magnus , Olaison Lars , Snygg‐Martin Ulrika , Pachirat Pimchitra , Pussadhamma Burabha , Senthong Vichai , Casey Anna , Elliott Tom , Lambert Peter , Watkin Richard , Eyton Christina , Klein John L. , Bradley Suzanne , Kauffman Carol , Bedimo Roger , Corey G. Ralph , Crowley Anna Lisa , Douglas Pamela , Drew Laura , Fowler Vance G. , Holland Thomas , Lalani Tahaniyat , Mudrick Daniel , Samad Zaniab , Sexton Daniel , Stryjewski Martin , Woods Christopher W. , Lerakis Stamatios , Cantey Robert , Steed Lisa , Wray Dannah , Dickerman Stuart A. , Bonilla Hector , DiPersio Joseph , Salstrom Sara‐Jane , Baddley John , Patel Mukesh , Stancoven Amy , Levine Donald , Riddle Jonathan , Rybak Michael , Cabell Christopher H. , Baloch Khaula , Corey G. Ralph , Dixon Christy C. , Fowler Vance G. , Harding Tina , Jones‐Richmond Marian , Sanderford Bob , Sanderford Bob , Stafford Judy , Stafford Judy , Anstrom Kevin , Athan Eugene , Bayer Arnold S. , Cabell Christopher H. , Corey G. Ralph , Fowler Vance G. , Hoen Bruno , Karchmer A. W. , Miró José M. , Murdoch David R. , Sexton Daniel J. , Bayer Arnold S. , Cabell Christopher H. , Chu Vivian , Corey G. Ralph , Durack David T. , Eykyn Susannah , Fowler Vance G. , Hoen Bruno , Miró José M. , Moreillon Phillipe , Olaison Lars , Raoult Didier , Rubinstein Ethan , Sexton Daniel J. 
Published: April 2016

Background

Host factors and complications have been associated with higher mortality in infective endocarditis (
IE
). We sought to develop and validate a model of clinical characteristics to predict 6‐month mortality in
IE
.

Methods and Results

Using a large multinational prospective registry of definite
IE
(International Collaboration on Endocarditis [
ICE
]–Prospective Cohort Study [
PCS
], 2000–2006, n=4049), a model to predict 6‐month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method. This model was externally validated in an independent prospective registry (
ICE
‐
PLUS
, 2008–2012, n=1197). The 6‐month mortality was 971 of 4049 (24.0%) in the
ICE
‐
PCS
cohort and 342 of 1197 (28.6%) in the
ICE
‐
PLUS
cohort. Surgery during the index hospitalization was performed in 48.1% and 54.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis),
IE
characteristics (prosthetic or nosocomial
IE
, causative organism, left‐sided valve vegetation), and
IE
complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated 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 (Harrell's C statistic 0.682), with a similar, independent benefit of surgery (hazard ratio 0.74, 95%
CI
0.62–0.89). A simplified risk model was developed by weight adjustment of these variables.

Conclusions

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 is performed less frequently in the highest risk patients. A simplified risk model may be used to identify specific risk subgroups in
IE
.