Validated Risk Score for Predicting 6-Month Mortality in Infective Endocarditis

Area of Science:

• Cardiology
• Infectious Diseases
• Clinical Epidemiology

Background:

• Host factors and complications are linked to increased mortality in infective endocarditis (IE).
• Predicting mortality in IE is crucial for patient management.
• Previous models may not fully capture the complexity of IE outcomes.

Purpose of the Study:

• To develop and validate a clinical model predicting 6-month mortality in infective endocarditis.
• To identify key host factors, IE characteristics, and complications associated with mortality.
• To assess the impact of surgery on IE survival.

Main Methods:

• Development of a predictive model using Cox proportional hazards modeling on a multinational prospective IE registry (ICE-PCS).
• Internal validation via bootstrapping and external validation in an independent registry (ICE-PLUS).
• Inverse probability weighting was used to account for surgery treatment.

Main Results:

• The 6-month mortality rate was approximately 24-29% across cohorts.
• Host factors (age, dialysis), IE characteristics (prosthetic IE, organism type), and complications (heart failure, stroke) predicted mortality.
• Surgery during hospitalization was associated with reduced mortality (HR 0.74) but was less frequent in high-risk patients.

Conclusions:

• Infective endocarditis carries a substantial 6-month mortality risk (≈25%).
• A validated model incorporating host factors, IE characteristics, and complications accurately predicts IE mortality.
• A simplified risk model can aid in identifying high-risk IE subgroups for targeted interventions, including timely surgery.