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The Predictive Value of Sepsis Scores for In-Hospital Mortality in Patients with Left-Sided Infective Endocarditis
Bianca Leal de Almeida1, Tania Mara Varejao Strabelli2, Marcio Sommer Bittencourt3,4
1Hospital das Clínicas, University of São Paulo Medical School, São Paulo 05403-010, SP, Brazil.
Tropical Medicine and Infectious Disease
|January 22, 2024
Summary
Sepsis scores like quick Sequential Organ Failure Assessment (qSOFA) and Sequential Organ Failure Assessment (SOFA) show lower accuracy in predicting mortality for infective endocarditis patients. This is likely due to cardiac dysfunction and embolic events being more common causes of death than sepsis itself.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Infective endocarditis (IE) presents unique clinical characteristics.
- The accuracy of standard sepsis scoring systems in IE patients remains uncertain.
Purpose of the Study:
- To evaluate the predictive accuracy of the quick Sequential Organ Failure Assessment (qSOFA) and Sequential Organ Failure Assessment (SOFA) scores for in-hospital mortality in patients with infective endocarditis.
Main Methods:
- A cohort of 517 patients with definite or possible left-sided infective endocarditis (diagnosed using Modified Duke Criteria) was analyzed.
- Receiver Operating Characteristic (ROC) curves were employed to assess the accuracy of qSOFA and SOFA scores in predicting in-hospital mortality.
Main Results:
- The overall in-hospital mortality rate was 28%.
- The area under the ROC curve for qSOFA was 0.601 and for SOFA was 0.679.
- In patients with pre-existing valve disease, the SOFA score (≥2) showed an ROC of 0.627, while in those without, it was 0.775.
Conclusions:
- Both qSOFA and SOFA scores are associated with increased in-hospital mortality in IE patients.
- The predictive accuracy of these sepsis scores is lower in IE compared to other bacterial infections.
- Mortality in IE is often attributed to cardiac dysfunction and embolic events, rather than direct sepsis, potentially explaining the lower score accuracy.
