1 Department of Clinical and Experimental Medicine - Section of Cardiology, University of Messina, Italy.
2 Aurora St. Luke's Medical Center, Milwaukee, USA.
Eur Heart J Acute Cardiovasc Care. 2019 Aug;8(5):476-484. doi: 10.1177/2048872617735809. Epub 2017 Oct 24.
Echocardiography is the main technique for the diagnosis of endocarditis in patients with bacteremia (SAB), but a consensus about performing transthoracic echocardiography or transesophageal echocardiography (TEE) as first-line tests is currently lacking. Recently, a new scoring system has been proposed by Palraj et al. to guide the use of TEE in this population. Our aim was to validate this scoring system or modify it, if necessary.
Data from SAB patients admitted from 2012 to 2014 were collected. We tested the Palraj scores to stratify patients' risk for endocarditis. Moreover, we analyzed our population to identify any other possible clinical predictors of endocarditis not included in the score. Endocarditis was diagnosed in 38 of 205 patients (18.5%). Palraj's score was effective in the detection of patients at high risk of endocarditis. In addition, we identified the presence of cardiac devices, prolonged bacteremia and intravenous drug abuse (IVDA) as elements strongly correlated with endocarditis. Two scoring systems (Day-1 and Day-5) were derived including IVDA as a variable. Using a Day-1 cut-off value ≥5 and a Day-5 cut-off value ≥2, the 'modified Palraj's score' showed sensitivities of 42.1% and 97.0% and specificities of 88.6% and 32.0% for Day-1 and Day-5 scores, respectively.
We modify and expand upon an effective scoring system to identify SAB patients at high risk for endocarditis in order to guide use of TEE. The inclusion of IVDA in the criteria for the calculation of the scores improves its effectiveness.
超声心动图是菌血症（SAB）患者诊断心内膜炎的主要技术，但目前对于行经胸超声心动图或经食管超声心动图（TEE）作为一线检查方法尚未达成共识。最近，Palraj 等人提出了一种新的评分系统来指导该人群中 TEE 的使用。我们的目的是验证该评分系统或在必要时进行修改。
收集了 2012 年至 2014 年 SAB 患者入院的数据。我们测试了 Palraj 评分来分层患者的心内膜炎风险。此外，我们分析了我们的人群，以确定评分系统中未包含的任何其他可能的与心内膜炎相关的临床预测因素。在 205 例患者中有 38 例（18.5%）诊断为心内膜炎。Palraj 评分对检测心内膜炎高危患者有效。此外，我们发现心脏器械的存在、长时间菌血症和静脉药物滥用（IVDA）与心内膜炎密切相关。我们得出了两个评分系统（第 1 天和第 5 天），包括 IVDA 作为一个变量。使用第 1 天的截断值≥5 和第 5 天的截断值≥2，“改良 Palraj 评分”在第 1 天和第 5 天的评分中的灵敏度分别为 42.1%和 97.0%，特异性分别为 88.6%和 32.0%。
我们对一种有效的评分系统进行了修改和扩展，以识别 SAB 患者中的心内膜炎高危患者，从而指导 TEE 的使用。将 IVDA 纳入评分标准的计算中可提高其有效性。
