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Clinical Rule for Infective Endocarditis in the Emergency Department Score: a prediction tool for infective endocarditis and its embolic events
Session:
SESSÃO DE POSTERS 15 - ENDOCARDITE INFECIOSA 2
Speaker:
Adriana Henriques Silva
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.3 Infective Endocarditis – Diagnostic Methods
Session Type:
Cartazes
FP Number:
---
Authors:
Adriana Henriques Silva; Liliana Brochado; Cristina Martins; Oliveira Baltazar; Nazar Ilchyshyn; João Mirinha Luz; Diogo Cunha; Tiago Lobão; Lourenço Aguiar; Bárbara Ferreira; Mariana Martinho; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri"><strong>Introduction: </strong>Infective endocarditis (IE) is a condition characterized by significant mortality and morbidity. It often presents with non-specific symptoms, leading to delays in recognition. The Clinical Rule for Infective Endocarditis in the Emergency Department (CREED) score is a clinical tool designed for risk stratification of IE in patients presenting with fever at the emergency department.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri"><strong>Purpose: </strong>Evaluate whether patients with a definitive diagnosis of IE actually had a high probability of IE as assessed by the CREED score. Also, we aim to assess whether high and very high-risk scores are associated with an increased number of complications, indications for surgery, and in-hospital death.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri"><strong>Methods </strong>Retrospective study analysing the CREED score profiles of patients with a confirmed IE with fever at admission, between 2006 and 2022 in a single center. Then, the study sample was divided into two groups: patients with very low and low risk (group 1), and patients with high and very high risk (group 2). We evaluated whether there were statistical differences in complications (paravalvular complications, embolic events, aneurysms, pseudoneurysms, abscesses, fistulas and septic shock), indication for surgery, and in-hospital death between the two groups.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri"><strong>Results: </strong>Of a total of 222 patients diagnosed with IE, 96 (43%) were eligible for the CREED score. Among these, 63 (66%) were classified as having a high or very high risk of IE, while 33 (34%) fell into the low or very low-risk categories.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri">Regarding baseline characteristics (age, sex, and personal medical history), there was a statistically significant difference between group 1 and group 2 only in the history of valvulopathy (27% vs 56%, p=0.008). There was no statistical difference between groups in complications for all causes (55% vs. 64%, p=0.343), but individually the group 2 was associated with an increased likehood of developing embolic events (OR 3.17; 95% CI 1.2-8.4; P=0.02). There was no statistical difference between groups in indication for surgery (30% vs 46%, p=0.136) and in-hospital mortality (21% vs.27%, p=0.535). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri"><strong>Conclusions: </strong>Our results indicate that the CREED score effectively identifies patients at high-risk of having infective endocarditis, while a low score does not exclude the diagnosis. However, this score can be useful for predicting embolic events. It is crucial combine risk stratification with clinical judgment for timely diagnosis of infective endocarditis.</span></span></p>
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