Mind the Gap: Inadequate Performance of Embolic Risk Scores in Infective Endocarditis.

Area of Science:

• Cardiology
• Infectious Diseases
• Clinical Risk Stratification

Background:

• Embolic events (EEs) are significant complications of infective endocarditis (IE).
• Three established scores exist to predict EEs: the Embolic Risk French Calculator, the Italian Endocarditis Study score, and the University of Campania "L. Vanvitelli" Napoli Score.
• External validation of these scores is essential for clinical utility.

Purpose of the Study:

• To externally validate and compare the predictive performance of three existing scores for embolic events in infective endocarditis.
• To assess the accuracy of these scores in identifying patients at high risk for EEs.
• To determine the need for more robust embolic risk stratification tools in IE management.

Main Methods:

• A multicenter retrospective study involving adult patients diagnosed with IE.
• Application of the Embolic Risk French Calculator, Italian Endocarditis Study score, and University of Campania score.
• Evaluation of score performance using sensitivity, specificity, and accuracy based on 2023 ISCVID Duke criteria.

Main Results:

• Among 1331 IE episodes, 51% experienced EEs.
• The Embolic Risk French Calculator, Italian Endocarditis Study score, and University of Campania score showed accuracies of 66%, 60%, and 63%, respectively.
• All three scores demonstrated limited predictive accuracy and frequent misclassification of patients.

Conclusions:

• Existing scores for predicting embolic events in infective endocarditis have limited predictive accuracy.
• Current tools frequently misclassify patients, underscoring the need for enhanced risk stratification strategies.
• Development of more robust tools is required for effective clinical guidance in managing embolic risk in IE.