Infective Endocarditis (IE) Mortality Risk Score

IE Mortality Risk Score

Mental Status Abnormality

Charlson Comorbidity Index ≥ 2

CHF (Moderate-Severe)

Bacterial Etiology Other Than Viridans Strep

Medical Rx Only (No Surgery)

Elevated CRP

IE Mortality Score: –

Awaiting input

Select all criteria to compute the score.

Predicts mortality at 6 months in patients with infective endocarditis.

Why Use

The IE Mortality Score provides an objective mortality estimate.

When to Use

Patients with confirmed IE to estimate mortality.

Formula

The IE Mortality Score is calculated by the addition of the selected points: Variable Points Constant 4 Host factors Age, years ≤45 0 46-60 2 61-70 3 >70 4 History of dialysis No 0 Yes 3 IE factors Nosocomial IE No 0 Yes 2 Prosthetic IE No 0 Yes 1 Symptoms >1 month before admission No 0 Yes -1 Staphylococcus aureus No 0 Yes 1 Viridans group streptococci No 0 Yes -2 Aortic vegetation No 0 Yes 1 Mitral vegetation No 0 Yes 1 IE complications NYHA class 3 or 4 heart failure No 0 Yes 3 Stroke No 0 Yes 2 Paravalvular complication No 0 Yes 2 Persistent bacteremia No 0 Yes 2 Surgical treatment No 0 Yes -2

Pearls / Pitfalls

Infective endocarditis (IE) has an overall 6-month mortality of approximately 25% in all-comers. Older age and history of dialysis appear to be the highest risk patient factors; IE complications also suggest a high mortality as well. Surgery is associated with a lower mortality rate but is infrequent in the high-risk cohort of patients. Mortality ranges from 10% in the lowest risk quintile to 53% in the highest-risk quintile. Points to keep in mind: Surgery in this study was associated with lower mortality, but the highest risk patients were less likely to receive surgery (probably because they were high-risk surgical patients as well). This study was performed in referral centers (likely tertiary and quaternary academic centers) with experience with endocarditis and cardiac surgery.

Advice

Patients with IE may benefit from consultation with cardiothoracic surgery and infectious disease services.

More Information

Interpretation: Probability of 6‐month mortality = 2.416*score+0.109*score 2 −4.849 A simplified risk score ≥8 had sensitivity 86.7% and specificity 50.8% for predicting overall 6‐month mortality (negative predictive value of 86% and positive predictive value of 39%).