SPC365

Performance of Guideline-suggested Risk Scores for Infective Endocarditis in a Real-World Cohort

Session: SESSÃO DE POSTERS 12 - ENDOCARDITE INFECIOSA 1
Speaker: Mariana Duarte Almeida

Congress: CPC 2025
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Cartazes
FP Number: ---
Authors: Mariana Duarte Almeida; Gonçalo Marques Ferreira; João Gouveia Fiuza; Oliver Correia Kungel; Francisco Rodrigues Santos; Vanda Devesa Neto; Nuno Craveiro
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">Introduction:</span></strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">&nbsp;Infective endocarditis (IE) is a disease with high mortality, in which positive blood cultures are a major criterion. <em>Staphylococcus aureus</em>&nbsp;is a common causative microorganism.&nbsp; There remains some uncertainty regarding the routine use of echocardiography in cases of positive blood cultures to investigate signs suggestive of IE.&nbsp; To support the decision to perform echocardiography, recent guidelines suggest the use of clinical scores that identify patients at high risk for&nbsp;<em>S. aureus</em>&nbsp;IE and, therefore, candidates for echocardiography. Transthoracic echocardiography (TTE) is the first-line imaging modality, while transesophageal echocardiography (TEE) plays a critical role in cases of high clinical suspicion or inconclusive TTE findings. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">Purpose:</span></strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">&nbsp;The aim of this study was to evaluate the applicability of guideline-recommended scores in a real-world cohort of pts, to inform their implementation in clinical practice.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">Methods:</span></strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">&nbsp;Retrospective data from pts with&nbsp;<em>S. aureus</em>&nbsp;positive blood cultures between January 2021, and December 2022, were analyzed. Data from pts who underwent echocardiography were analyzed and compared based on whether they met the modified Duke criteria for a definitive IE diagnosis or not. Demographic, laboratory, imaging parameters, and clinical outcomes were collected. Statistical analyses included Chi-square tests and Independent t-tests for group comparisons. Binary logistic regression assessed the predictive performance of the scores, and Receiver Operating Characteristic (ROC) curves with corresponding Areas Under the Curve (AUC) were used to analyze model discrimination.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">Results:</span></strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">&nbsp;Of the 222 pts included, 77 (mean age: 73.5 &plusmn; 13.0 years, range 28&ndash;95) underwent echocardiography for IE evaluation, of whom 22 (28.6%) underwent TEE. Among these, 13.0% (n=10) met criteria for a definitive diagnosis of IE. Compared to pts without IE, those with a definitive diagnosis had significantly higher VIRSTA scores (7.4 &plusmn; 3.1 vs. 3.1 &plusmn; 2.8, p&lt;0.001) and POSITIVE scores (5.8 &plusmn; 3.3 vs. 0.9 &plusmn; 2.0, p&lt;0.001). The PREDICT score was also higher (2.2 &plusmn; 1.1 vs. 1.9 &plusmn; 1.0) but without&nbsp;significance (p=0.173). Positive associations between guideline-recommended cut-offs and the presence of IE were observed for VIRSTA (&ge;3, p=0.006) and POSITIVE (&ge;4, p&lt;0.001), but not for PREDICT (&ge;4, p=0.780). VIRSTA and POSITIVE scores predicted IE diagnosis with odds ratios of 11.8 (p=0.023) and 20.4 (p&lt;0.001), respectively. ROC analysis showed AUC values of 0.734 (p=0.022; 95% CI: 0.581&ndash;0.871) for the VIRSTA score and 0.818 (p=0.001; 95% CI: 0.665&ndash;0.971) for the POSITIVE score.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">Conclusion:</span></strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">&nbsp;The POSITIVE and VIRSTA scores demonstrated good predictive accuracy for infective endocarditis in our population and may guide the decision to perform echocardiography to assess imaging criteria for IE in clinical practice. Conversely, the PREDICT score did not appear as useful in our reality.</span></span></span></span></p>