What is the Advantage of using Risk Score in Infective Endocarditis: An Opinion

Abstract

Infectious endocarditis (IE) is a very heterogeneous condition, which often requires surgical treatment. Even with surgical treatment, 30-day mortality rate can be high. A risk stratification is needed for the individual prognosis of the patient, but also for quality of care. Existing scores such as EuroSCORE II and STS scores do not include specific IE related parameters and give a poor assessment of the prognosis.

A literature search was made in Web of Science for existing risk scores. The use of secondary references from comparative series proved to be necessary.

Eight useful manuscripts could be identified in which a model was constructed. Two more comparative manuscripts are also found. Regression coefficients were mostly used to achieve this aim. However, there is considerable variation in study design, inclusion of patients and of risk factors. Definitions of risk factors and length of inclusion also vary. Five factors are of major importance: hemodynamic status, renal dysfunction, age, prosthetic valve infection and periannular involvement. In only one report medically treated patients are included which allows inclusion surgery itself as a factor.

Hemodynamic status (including heart failure and need for mechanical support), renal dysfunction and age prove in most instances to be the dominant factors, but more specific IE related factors such as microbial data, Periannular involvement and cardiac damage should not be neglected. Because of the lengthy inclusion time, improvement of operative and postoperative care should be taken into consideration. These models have a potential value, but continuous recalibration, based on future international prospective data collection (such as in ICE-PCS) is necessary.