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Infective endocarditis risk scores: a narrative review
Cindy Sun-Yan Cho1, Kevin Lim1, Ivan Chi-Hin Siu1
1Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, Hong Kong, China.
Background And Objective:
Despite modern advancements, infective endocarditis remains a devastating disease with high mortality and morbidity rates. Given the heterogeneous patient background and the complexity of the condition, the decision for surgery is difficult. Traditional general cardiac surgery risk models, including EuroSCORE and Society of Thoracic Surgeons (STS) score, do not include disease-specific factors that often impact both the operability and frailty of patients. The aim of the study is to review the strength and limitations of current risk scores designed specifically for patients with infective endocarditis.
Methods:
A search in PubMed and OVID databases was conducted for articles and abstracts published from inception to 1st June 2024 using the terms "infective endocarditis" AND "risk score" or "surgical futility" or "operative mortality".
Key Content And Findings:
Various risk scores have therefore been developed to help stratify the operative risks of these patients by incorporating endocarditis-specific features. This review aims to analyse the applicability and usefulness of risk scores in the setting of surgical management of infective endocarditis, which in turn helps to identify patients who would benefit from interventions. From 2007, a total of 18 risk scores have been designed specifically for patients with infective endocarditis. These scores however have low generalisability since different patient characteristics, disease factors and validation strategies are used. In various validation cohorts and comparative studies, the discrimination performances of these scores are unsatisfactory. Most of the studies focused on early, or in-patient mortality, while the intermediate and long-term mortality was not well studied.
Conclusions:
Risk stratification for the group of patients who are indicated for surgery, but only received medical treatment due to perceived futility or were too unstable to proceed to operation, is pertinent. This population is not frequently recruited to current studies, and more research is needed.
