Risk prediction in infective endocarditis by modified MELD-XI score
- 88 Downloads
The suitability of the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score to predict adverse outcomes in infective endocarditis (IE) patients remains uncertain. This study was performed to explore the prognostic value of the MELD-XI score and modified MELD-XI score for patients with IE. A total of 858 patients with IE were consecutively enrolled and classified into two groups: MELD-XI ≤ 10 (n = 588) and MELD-XI > 10 (n = 270). Multivariate analysis was performed to determine risk factors independent of MELD-XI score. Higher MELD-XI score was associated with higher in-hospital mortality (15.6 vs. 4.8%, p < 0.001) and major adverse clinical events (33.3 vs. 18.4%, p < 0.001). MELD-XI score was an independent predictor of in-hospital death (odds ratio [OR] = 1.06, 95% CI, 1.02–1.10, p = 0.005). Based on a multivariate analysis, NYHA class III or IV (3 points), C-reactive protein > 9.5 mg/L (4 points), and non-surgical treatment (6 points) were added to MELD-XI score. Modified MELD-XI score produced higher predictive power than previous (AUC 0.823 vs. 0.701, p < 0.001). The cumulative incidence of long-term mortality (median 29 months) was significantly higher in patients with modified MELD-XI score > 13 than those without (log-rank = 25.30, p < 0.001). Modified MELD-XI score was independently associated with long-term mortality (hazard ratio = 1.08, 95% CI, 1.04–1.12, p < 0.001). MELD-XI score could be used as a risk assessment tool in IE. Furthermore, modified MELD-XI score remained simple and more effective in predicting poor prognosis.
KeywordsInfective endocarditis Risk score Prognosis
This study was supported by Science and Technology Projects of Guangdong (grant no. 2017ZC0331).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
The present study was conducted in Guangdong general hospital and approved by the hospital ethics committee.
Written informed consent was obtained.
- 3.Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del ZF, Dulgheru R, El KG, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos MP, Vilacosta I, Zamorano JL, Erol C, Nihoyannopoulos P, Aboyans V, Agewall S, Athanassopoulos G, Aytekin S, Benzer W, Bueno H, Broekhuizen L, Carerj S, Cosyns B, De Backer J, De Bonis M, Dimopoulos K, Donal E, Drexel H, Flachskampf FA, Hall R, Halvorsen S, Hoen B, Kirchhof P, Lainscak M, Leite-Moreira AF, Lip GY, Mestres CA, Piepoli MF, Punjabi PP, Rapezzi C, Rosenhek R, Siebens K, Tamargo J, Walker DM (2015) 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 36:3075–3128CrossRefPubMedGoogle Scholar
- 4.Park LP, Chu VH, Peterson G, Skoutelis A, Lejko-Zupa T, Bouza E, Tattevin P, Habib G, Tan R, Gonzalez J, Altclas J, Edathodu J, Fortes CQ, Siciliano RF, Pachirat O, Kanj S, Wang A (2016) Validated risk score for predicting 6-month mortality in infective endocarditis. J Am Heart Assoc 5:e3016CrossRefGoogle Scholar
- 5.Chu VH, Park LP, Athan E, Delahaye F, Freiberger T, Lamas C, Miro JM, Mudrick DW, Strahilevitz J, Tribouilloy C, Durante-Mangoni E, Pericas JM, Fernandez-Hidalgo N, Nacinovich F, Rizk H, Krajinovic V, Giannitsioti E, Hurley JP, Hannan MM, Wang A (2015) Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the international collaboration on endocarditis. Circulation 131:131–140CrossRefPubMedGoogle Scholar
- 7.Martinez-Selles M, Munoz P, Arnaiz A, Moreno M, Galvez J, Rodriguez-Roda J, de Alarcon A, Garcia CE, Farinas MC, Miro JM, Montejo M, Moreno A, Ruiz-Morales J, Goenaga MA, Bouza E (2014) Valve surgery in active infective endocarditis: a simple score to predict in-hospital prognosis. Int J Cardiol 175:133–137CrossRefPubMedGoogle Scholar
- 13.Forman DE, Butler J, Wang Y, Abraham WT, O'Connor CM, Gottlieb SS, Loh E, Massie BM, Rich MW, Stevenson LW, Young JB, Krumholz HM (2004) Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol 43:61–67CrossRefPubMedGoogle Scholar
- 22.Mirabel M, Sonneville R, Hajage D, Novy E, Tubach F, Vignon P, Perez P, Lavoue S, Kouatchet A, Pajot O, Mekontso-Dessap A, Tonnelier JM, Bollaert PE, Frat JP, Navellou JC, Hyvernat H, Hssain AA, Timsit JF, Megarbane B, Wolff M, Trouillet JL (2014) Long-term outcomes and cardiac surgery in critically ill patients with infective endocarditis. Eur Heart J 35:1195–1204CrossRefPubMedGoogle Scholar
- 23.Fernandez-Hidalgo N, Almirante B, Tornos P, Gonzalez-Alujas MT, Planes AM, Larrosa MN, Sambola A, Igual A, Pahissa A (2011) Prognosis of left-sided infective endocarditis in patients transferred to a tertiary-care hospital—prospective analysis of referral bias and influence of inadequate antimicrobial treatment. Clin Microbiol Infect 17:769–775CrossRefPubMedGoogle Scholar
- 24.Olmos C, Vilacosta I, Habib G, Maroto L, Fernández C, López J, Sarriá C, Salaun E, Di Stefano S, Carnero M, Hubert S, Ferrera C, Tirado G, Freitas-Ferraz A, Sáez C, Cobiella J, Bustamante-Munguira J, Sánchez-Enrique C, García-Granja PE, Lavoute C, Obadia B, Vivas D, Gutiérrez Á, San Román JA (2017) Risk score for cardiac surgery in active left-sided infective endocarditis. Heart 103:1435–1442CrossRefPubMedGoogle Scholar
- 29.Ambrosy AP, Vaduganathan M, Huffman MD, Khan S, Kwasny MJ, Fought AJ, Maggioni AP, Swedberg K, Konstam MA, Zannad F, Gheorghiade M (2012) Clinical course and predictive value of liver function tests in patients hospitalized for worsening heart failure with reduced ejection fraction: an analysis of the EVEREST trial. Eur J Heart Fail 14:302–311CrossRefPubMedGoogle Scholar