Abstract of the day - Can we predict 30-day mortality risk in patients with left-sided infective endocarditis?

Despite diagnostic and therapeutic advances, infective endocarditis (IE) is associated with high in-hospital mortality.

Today, Doctor Jordi Lozano Torres (University Hospital Vall d'Hebron - Barcelona, Spain) describes the development and validation of a new risk calculator, the EURO-ENDO score, which aims to help predict 30-day mortality in left-sided IE.

Data from patients with a diagnosis of possible or definite left-­sided IE, based on ESC 2015 criteria, were retrieved from the prospective multicentre ESC-EURObservational Research Programme (EORP) European Infective Endocarditis (EURO-ENDO) registry. Of 2,171 patients analysed, 257 patients (11.8%) died during the first 30 days of IE diagnosis. Using multivariable logistic regression, eleven variables were identified that were associated with 30-­day mortality: previous cardiac surgery, previous stroke/transient ischaemic attack, creatinine >2 mg/dL, Staphylococcus aureus infection, embolic events on admission, heart failure (HF) or cardiogenic shock, vegetation size >14 mm, presence of abscess, severe regurgitation, double left­-sided IE and no left-valve surgery. The odds ratio (OR) for 30-day mortality with left-valve surgery was 0.19 (95% CI 0.13 to 0.28; p<0.001). For the other variables, the OR for 30-day mortality ranged from 1.44 for embolic events on admission to 2.94 for HF or cardiogenic shock in patients with left-valve surgery. In patients without left-valve surgery, the OR for 30-day mortality ranged from 1.13 for the presence of an abscess to 3.02 for heart failure or cardiogenic shock.

The risk score was found to provide an accurate individualised estimation of 30­-day mortality, both for patients undergoing left-valve surgery and those who did not, with an area under the receiver operator curve of 0.798 and 0.758, respectively. In addition, the Hosmer-­Lemeshow test showed that the model was well calibrated (0.085 and 0.09, respectively).

For a condition associated with such poor prognosis, it is hoped that the EURO-ENDO score will help guide clinical-decision making, such as selecting the most appropriate surgical candidates, to improve outcomes. You can learn more about predicting outcomes in IE in one of today’s Science Box sessions, which also includes an analysis from the ESC-EORP EURO­-ENDO registry evaluating current management and survival of patients with left-­sided IE complicated by chronic HF.