Itelman Edward, Sharony Ram, Hamdan Ashraf, Atamna Alaa, Shaked Hila, Rubchevsky Victor, Barak Yaron D, Bernstine Hanna, Shapira Yaron, Vaturi Mordehay, Epstein Hadass Ofek, Kornowski Ran, Orvin Katia
Cardiology Division, Rabin Medical Center, Petach Tikva 49100, Israel.
Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
J Clin Med. 2024 Aug 20;13(16):4917. doi: 10.3390/jcm13164917.
Despite diagnostic and therapeutic advances, infective endocarditis (IE) is still associated with high mortality rates. Currently, there are no good prognostic tools for the risk assessment of patients with IE. The CHADS-VASc score, used to estimate the risk of ischemic stroke in patients with non-valvular atrial fibrillation (AF), has been shown to be a powerful predictor of stroke and death in patients without known AF associated with other cardiovascular conditions. We aimed to evaluate the usefulness of the CHADS-VASc score as a prognostic tool in a population of patients with IE. The Rabin Medical Center Endocarditis Team (RMCET) registry is a retrospective cohort of all patients evaluated at our center due to acute or sub-acute bacterial endocarditis. The CHADS-VASc score was extracted for all patients. All-cause mortality was depicted for all patients. The cohort included 330 patients with a mean age of 65.2 ± 14.7 years (70% men). During a median follow-up of 24 months [IQR 4.7-48.6], 121 (36.7%) patients died. The median CHADS-VASc score was 3, and any score above 2 was associated with increased overall mortality (50.8% vs. 19.9%, < 0.001). A multivariate model incorporating important confounders not included in the CHADS-VASc model showed consistent results with a risk increase of 121% for the higher CHADS-VASc score groups (HR 2.21 [CI 1.12-4.39], = 0.023). IE currently has no good risk stratification models for clinical practice. The CHADS-VASc score might serve as a simple and available tool to stratify risk among patients with IE.
尽管在诊断和治疗方面取得了进展，但感染性心内膜炎（IE）的死亡率仍然很高。目前，对于IE患者的风险评估尚无良好的预后工具。用于评估非瓣膜性心房颤动（AF）患者缺血性中风风险的CHADS-VASc评分，已被证明是无已知AF但伴有其他心血管疾病患者中风和死亡的有力预测指标。我们旨在评估CHADS-VASc评分作为IE患者群体预后工具的实用性。拉宾医疗中心心内膜炎研究团队（RMCET）登记处是对因急性或亚急性细菌性心内膜炎在我们中心接受评估的所有患者进行的回顾性队列研究。提取了所有患者的CHADS-VASc评分。描述了所有患者的全因死亡率。该队列包括330例患者，平均年龄为65.2±14.7岁（70%为男性）。在中位随访24个月[四分位间距4.7 - 48.6]期间，121例（36.7%）患者死亡。CHADS-VASc评分中位数为3，任何高于2的评分都与总体死亡率增加相关（50.8%对19.9%，<0.001）。纳入CHADS-VASc模型未包含的重要混杂因素的多变量模型显示出一致的结果，CHADS-VASc评分较高组的风险增加121%（风险比2.21[可信区间1.12 - 4.39]，=0.023）。目前IE在临床实践中尚无良好的风险分层模型。CHADS-VASc评分可能作为一种简单且可用的工具，用于IE患者的风险分层。
