Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Division of Infectious Diseases, Mayo Clinic, Phoenix, Arizona, USA.
Clin Infect Dis. 2021 Oct 5;73(7):e1745-e1753. doi: 10.1093/cid/ciaa844.
Infective endocarditis (IE) is the most feared complication of Staphylococcus aureus bacteremia (SAB). Transesophageal echocardiogram (TEE) is generally recommended for all patients with SAB; however, supporting data for this are limited. We previously developed a scoring system, "PREDICT," that quantifies the risk of IE and identifies patients who would most benefit most from undergoing TEE. The current prospective investigation aims to validate this score.
We prospectively screened all consecutive adults (≥18 years) hospitalized with SAB at 3 Mayo Clinic sites between January 2015 and March 2017.
Of 220 patients screened, 199 with SAB met study criteria and were included in the investigation. Of them, 23 (11.6%) patients were diagnosed with definite IE within 12 weeks of initial presentation based on modified Duke's criteria. Using the previously derived PREDICT model, the day 1 score of ≥4 had a sensitivity of 30.4% and a specificity of 93.8%, whereas a day 5 score of ≤2 had a sensitivity and negative-predictive value of 100%. Additional factors including surgery or invasive procedure in the past 30 days, prosthetic heart valve, and higher number of positive blood culture bottles in the first set of cultures were associated with increased risk of IE independent of the day 5 risk score.
We validated the previously developed PREDICT scoring tools for stratifying risk of IE, and the need for undergoing a TEE, among cases of SAB. We also identified other factors with predictive potential, although larger prospective studies are needed to further evaluate possible enhancements to the current scoring system.
感染性心内膜炎（IE）是金黄色葡萄球菌菌血症（SAB）最可怕的并发症。一般建议对所有 SAB 患者进行经食管超声心动图（TEE）检查；然而，支持这一检查的证据有限。我们之前开发了一种评分系统“PREDICT”，用于量化 IE 风险，并确定最需要接受 TEE 的患者。本次前瞻性研究旨在验证该评分系统。
我们前瞻性筛选了 2015 年 1 月至 2017 年 3 月期间在 3 家 Mayo 诊所住院的所有连续成年（≥18 岁）SAB 患者。
在筛选的 220 例患者中，有 199 例符合 SAB 研究标准并纳入研究。其中，根据改良的 Duke 标准，在最初出现症状后的 12 周内，有 23 例（11.6%）患者被诊断为明确的 IE。使用之前推导的 PREDICT 模型，第 1 天的评分≥4 时具有 30.4%的敏感性和 93.8%的特异性，而第 5 天的评分≤2 时具有 100%的敏感性和阴性预测值。包括过去 30 天内手术或有创操作、人工心脏瓣膜以及第一组培养物中阳性血培养瓶数量增加等其他因素与 IE 风险增加独立相关，而与第 5 天风险评分无关。
我们验证了之前开发的 PREDICT 评分工具，用于分层 SAB 患者 IE 风险和进行 TEE 的必要性。我们还确定了其他具有预测潜力的因素，但需要更大的前瞻性研究来进一步评估对当前评分系统的可能改进。
