评估感染性内心炎的风险在黄金杆菌菌菌:一个比较4个评分系统
Marin Delaunay1, Christian Creveuil2, Sylvie Dargère1
1Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Caen, Normandie Univ, Caen, France.
概括
维尔斯塔评分有效地识别了感染性内心炎 (IE) 风险较低的黄金杆菌菌菌菌病 (SAB) 患者. 临床判断虽然有用,但对于指导心声回声学决策至关重要.
科学领域:
- 传染性疾病 传染性疾病
- 心脏病学 心脏病学
- 医学诊断 医学诊断 医学诊断
背景情况:
- 诊断感染性内心炎 (IE) 在黄金杆菌菌菌菌病 (SAB) 患者的治疗对管理至关重要.
- 现有几个预测分数来评估IE风险和指导心声回声学的使用,旨在减少不必要的程序.
研究的目的:
- 在SAB患者中评估和比较四个IE预测分数 (PREDICT,VIRSTA,POSITIVE,LAUSTAPHEN) 的性能.
- 评估这些得分对心声回声学利用的潜在影响.
主要方法:
- 在2017年1月至2022年12月期间住院的SAB病例的回顾性分析.
- 基于修改的杜克标准的IE诊断.
- 四个IE预测分数的计算和比较:PREDICT (第1天和第5天),VIRSTA,POSITIVE和LAUSTAPHEN. 这四个IE预测分数的计算和比较.
主要成果:
- 在887名SAB患者中,75名 (8.4%) 患有IE. 维尔斯塔和劳斯塔芬显示了100%的灵敏度和负预测值 (NPV).
- 通过AUC ROC分析,VIRSTA (90.4) 和POSITIVE (89.4) 显示出最高的区分能力.
- 评分的应用可能会显著改变心声回声的使用,可能会增加389.1% (VIRSTA) 的跨食道心声回声 (TEE) 或减少95.4%的跨体心声回声 (TTE) (PREDICT D1).
结论:
- VIRSTA评分可靠地识别了IE的低风险SAB患者,而LAUSTAPHEN显示了需要进一步验证的可比性能.
- 尽管分辨能力很高,但评分系统的有限特异性可能导致TEE过度使用.
- 临床判断应该指导心声回声学决定,而不仅仅依赖评分系统.
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