Score For Prognosis Assessment In Patients With Infective Endocarditis

Prognosis; Endocarditis,Bacterial; Inpatients; Electronic Health Records

Prognóstico; Endocardite Bacteriana; Pacientes Internados; Registros Eletrônicos de Saúde

Prognosis; Endocarditis,Bacterial; Inpatients; Electronic Health Records

Prognóstico; Endocardite Bacteriana; Pacientes Internados; Registros Eletrônicos de Saúde

Structured prognostic estimation criteria are a key issue in patient treatment and can be an additional help to guide appropriate patient counseling, as well as support therapeutic decisions for doctors responsible for patients.¹ Prognostic assessment can also be expressed as risk scores; many of them were developed for case series of epidemiological population studies²-⁴ or a specific group of patients such as patients in intensive care⁵-⁷ with suspected or active cardiovascular disease²,⁸,⁹ or a specific disease such as infective endocarditis.¹⁰

In the present publication,¹¹ the authors evaluated in-hospital and post-discharge prognosis estimates using the “Sharpen” score in comparison to the Charlson comorbidity index in 168 patients (179 admissions) with infective endocarditis over sixteen years (2000-2016) based on the review of hospital records. Sharpen is an acronym for seven clinical conditions (Systolic Blood Pressure, Heart Failure, Age, Renal Function, Pneumonia, Elevated C-reactive protein Rate, and Non-Use of Intravenous Drugs – SHARPEN) subjected to multivariate analysis (logistic regression) converting β coefficients into weights.¹²

In the series published in this issue,¹¹ Staphylococcus aureus was the most common microorganism (86%). Sixty-eight patients underwent surgery due to index acute heart failure (79.4%) or uncontrolled infection (41.2%). They concluded that the Sharpen score had an appropriate performance in relation to the Charlson comorbidity index and perhaps better accuracy (72.1, range 59.8-82.3 vs. 62, range 54.5-69.1) in non-operated patients, despite some overlap in the ranges of accuracy.

Interestingly, clinical conditions that were precursors to complications were the variables in the score studied, as well as other prognostic studies.¹⁰ From a clinical perspective, age, sex, microorganism infection and cardiac conditions and comorbidities should not be missing from the risk estimate regardless of a coefficient value; numbers do not always translate relevant clinical information without a validation phase. The presence of complications has long been recognized as an unfavorable prognostic index, especially in endocarditis caused by Staphylococcus aureus¹³ and other clinical variables such as infections caused by microorganisms and surgery.¹⁰ Surgery can sometimes modify the proportionality of risks during the treatment period, meaning that some assumptions, flaws for the statistical model based on proportional risks, may not meet the assumptions of statistical modeling.¹⁴,¹⁵

Endocarditis is a rare disease, and each case can present very individual characteristics that can make it difficult to translate group case analysis, generally retrospective, into the clinical practice of individual decisions.¹⁵,¹⁶ For doctors, careful clinical supervision of each patient and timely diagnosis of the clinical condition and complications contribute to the success of medical and surgical therapies in patients with infective endocarditis, including those at high risk.¹⁷

References

• ¹ Kent DM, Paulus JK, van Klaveren D, D'Agostino R, Goodman S, Hayward R, Ioannidis JPA, Patrick-Lake B, Morton S, Pencina M, Raman G, Ross JS, Selker HP, Varadhan R, Vickers A, Wong JB, Steyerberg EW. The Predictive Approaches to Treatment effect Heterogeneity (PATH) Statement. Ann Intern Med. 2020 Jan 7;172(1):35-45. doi: 10.7326/M18-3667. Epub 2019 Nov 12. PMID: 31711134; PMCID: PMC7531587.
  » https://doi.org/10.7326/M18-3667
• ² D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008 Feb 12;117(6):743-53. doi:10.1161/CIRCULATIONAHA.107.699579. Epub 2008 Jan 22. PMID: 18212285.
  » https://doi.org/10.1161/CIRCULATIONAHA.107.699579
• ³ Cui J. Overview of risk prediction models in cardiovascular disease research. Ann Epidemiol. 2009 Oct;19(10):711-7. doi: 10.1016/j.annepidem.2009.05.005. Epub 2009 Jul 22. PMID: 19628409
  » https://doi.org/10.1016/j.annepidem.2009.05.005
• ⁴ Feliciano SCDC, Villela PB, Oliveira GMM. Association between Mortality from Chronic Noncommunicable Diseases and Human Development Index in Brazil between 1980 and 2019. Arq Bras Cardiol. 2023 Apr 21;120(4):e20211009. doi: 10.36660/abc.20211009. eCollection 2023. PMID: 37098983 Free PMC article. English, Portuguese.
  » https://doi.org/10.36660/abc.20211009
• ⁵ Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, Sirio CA, Murphy DJ, Lotring T, Damiano A, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991 Dec;100(6):1619-36. doi: 10.1378/chest.100.6.1619. PMID: 1959406.
  » https://doi.org/10.1378/chest.100.6.1619
• ⁶ e Silva LGA, de Maio Carrilho CMD, Talizin TB, Cardoso LTQ, Lavado EL, Grion CMC. Risk factors for hospital mortality in intensive care unit survivors: a retrospective cohort study. Acute Crit Care. 2023 Feb;38(1):68-75. doi:10.4266/acc.2022.01375. Epub 2023 Feb 27. PMID: 36935536; PMCID: PMC10030242.
  » https://doi.org/10.4266/acc.2022.01375
• ⁷ Koozi H, Lidestam A, Lengquist M, Johnsson P, Frigyesi A. A simple mortality prediction model for sepsis patients in intensive care. J Intensive Care Soc. 2023 Nov;24(4):372-378. doi: 10.1177/17511437221149572. Epub 2023 Feb 1. PMID: 37841294; PMCID: PMC10572475.
  » https://doi.org/10.1177/17511437221149572
• ⁸ van Dijk WB, Leeuwenberg AM, Grobbee DE, Siregar S, Houterman S, Daeter EJ, de Vries MC, Groenwold RHH, Schuit E; Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration. Dynamics in cardiac surgery: trends in population characteristics and the performance of the EuroSCORE II over time. Eur J Cardiothorac Surg. 2023 Sep 7;64(3):ezad301. doi: 10.1093/ejcts/ezad301. PMID: 37672025; PMCID: PMC10504469.
  » https://doi.org/10.1093/ejcts/ezad301
• ⁹ Lederman C, Ferreira JFM, Albuquerque CP, Lima ACP, Barroso LP, Souza JCM, Lima VHV, Castro GJ, Luduvice NZ, Morais LCC, Perdigao ML, Freitas RMV, Teixeira ML, Waldvogel BC, Mansur AJ. Mortality after discharge from a public tertiary cardiovascular referral hospital. Medicine (Baltimore). 2023 Apr 21;102(16):e33627. doi: 10.1097/MD.0000000000033627. PMID: 37083767; PMCID: PMC10118353.
  » https://doi.org/10.1097/MD.0000000000033627
• ¹⁰ Hasbun R, Vikram HR, Barakat LA, Buenconsejo J, Quagliarello VJ. Complicated left-sided native valve endocarditis in adults: risk classification for mortality. JAMA. 2003 Apr 16;289(15):1933-40. doi: 10.1001/jama.289.15.1933. PMID: 12697795.
  » https://doi.org/10.1001/jama.289.15.1933
• ¹¹ Alves SG, Pivatto Júnior F, Filippini FB, Dannenhauer GP, Seroiska G, Bischoff HM, et al. Performance of the SHARPEN Score and the Charlson Comorbidity Index for In-Hospital and Post-Discharge Mortality Prediction in Infective Endocarditis. Arq Bras Cardiol. 2023; 120(12):e20230441. DOI: https://doi.org/10.36660/abc.20230441
  » https://doi.org/10.36660/abc.20230441
• 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.
• ¹³ Mansur AJ, Grinberg M, Cardoso RH, da Luz PL, Bellotti G, Pileggi F. Determinants of prognosis in 300 episodes of infective endocarditis. Thorac Cardiovasc Surg. 1996 Feb;44(1):2-10. doi: 10.1055/s-2007-1011974. PMID: 8721393.
  » https://doi.org/10.1055/s-2007-1011974
• ¹⁴ Tleyjeh IM, Ghomrawi HM, Steckelberg JM, Hoskin TL, Mirzoyev Z, Anavekar NS, Enders F, Moustafa S, Mookadam F, Huskins WC, Wilson WR, Baddour LM. The impact of valve surgery on 6-month mortality in left-sided infective endocarditis. Circulation. 2007 Apr 3;115(13):1721-8. doi: 10.1161/CIRCULATIONAHA.106.658831. Epub 2007 Mar 19. PMID: 17372170.
  » https://doi.org/10.1161/CIRCULATIONAHA.106.658831
• ¹⁵ Wang A, Chu VH, Athan E, Delahaye F, Freiberger T, Lamas C, Miro JM, Strahilevitz J, Tribouilloy C, Durante-Mangoni E, Pericas JM, Fernández-Hidalgo N, Nacinovich F, Barsic B, Giannitsioti E, Hurley JP, Hannan MM, Park LP; ICE-PLUS Investigators. Association between the timing of surgery for complicated, left-sided infective endocarditis and survival. Am Heart J. 2019 Apr;210:108-116. doi: 10.1016/j.ahj.2019.01.004. Epub 2019 Jan 17. Erratum in: Am Heart J. 2019 Jun;212:165. PMID: 30802708.
  » https://doi.org/10.1016/j.ahj.2019.01.004
• ¹⁶ Dahabreh IJ, Hayward R, Kent DM. Using group data to treat individuals: understanding heterogeneous treatment effects in the age of precision medicine and patient-centred evidence. Int J Epidemiol. 2016 Dec 1;45(6):2184-2193. doi: 10.1093/ije/dyw125. PMID: 27864403; PMCID: PMC5841616.
  » https://doi.org/10.1093/ije/dyw125
• ¹⁷ Kent DM. Overall average treatment effects from clinical trials, one-variable-at-a-time subgroup analyses and predictive approaches to heterogeneous treatment effects: Toward a more patient-centered evidence-based medicine. Clin Trials. 2023 Aug;20(4):328-337. doi: 10.1177/17407745231171897. Epub 2023 May 6. PMID: 37148125.
  » https://doi.org/10.1177/17407745231171897

• Short Editorial related to the article: Performance of the SHARPEN Score and the Charlson Comorbidity Index for In-Hospital and Post-Discharge Mortality Prediction in Infective Endocarditis

Publication Dates

• Publication in this collection
  23 Aug 2024
• Date of issue
  2023

History

• Received
  24 Nov 2023
• Reviewed
  06 Dec 2023
• Accepted
  06 Dec 2023