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In-hospital mortality in infective endocarditis: a score comparison
Session:
Comunicações Orais - Sessão 28 - Doença Valvular e Endocardite
Speaker:
João Gouveia Fiuza
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.8 Infective Endocarditis - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João Gouveia Fiuza; Vanda Devesa Neto; Gonçalo RM Ferreira; Joana Laranjeira Correia; Júlio Gil Pereira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Introduction:</span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black"> Infective endocarditis (IE) is associated with high level of mortality. It is crucial to promptly identify patients with higher risk. SHARPEN score (Systolic BP, Heart failure, Age, Renal function, Pneumonia, Elevated peak CRP, and Non-intravenous drug abusers) was developed to predict in hospital mortality (IHM) in patients presenting with IE. SOFA score is commonly used to predict clinical outcomes of critically ill patients.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Purpose:</span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black"> Evaluate SHARPEN’s score (ShS) performance and how it compares to the SOFA score (SS) in predicting in-hospital mortality.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Methods: </span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Retrospective study of 64 patients admitted for IE in a Cardiology Department from 2018 to 2022. Baseline characteristics, microbiological and imaging findings and disease severity were analyzed. SHARPEN score was calculated at admission, and each patient was classified as low-moderate (ShLM) (2-10 points) or high (ShH) (11-20 points) risk. The SOFA score was also calculated at admission, and the population was divided into two groups: SC 0-6 points (SSL) and SC </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">≥</span></span></span><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">7 points (SSH). Chi-square and Mann-Whitney U were used for comparison between groups and IHM. Discrimination for in-hospital mortality was assessed with the ROC curve.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Results:</span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black"> Mean age was 68±77 years; 67,2% were men. IHM was 25%. 56,3% of patients had ShH. 28,1% of patients had SSH. Patients in ShH group had greater prevalence of previous diagnosis of heart failure (50% vs 7,1%; x</span></span></span><span style="font-size:10.5pt"><span style="font-family:Symbol"><span style="color:black"><sup>2</sup></span></span></span><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">= 13,465; p<0,01; OR =13), acute kidney injury (91,7% vs 32,1%; x</span></span></span><span style="font-size:10.5pt"><span style="font-family:Symbol"><span style="color:black"><sup>2</sup></span></span></span><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">= 24,737; p<0,01; OR =23,22), anemia during hospital stay (100% vs 82,1%; x</span></span></span><span style="font-size:10.5pt"><span style="font-family:Symbol"><span style="color:black"><sup>2</sup></span></span></span><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">= 6,973; p=0,01), admission lower hemoglobin (p<0,01), higher leucocyte and creatinine measurements (p=0,05 and p<0,01, respectively). Patients in SSH group had greater prevalence of chronic kidney disease (44,4% vs 10,87%; x</span></span></span><span style="font-size:10.5pt"><span style="font-family:Symbol"><span style="color:black"><sup>2</sup></span></span></span><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">= 9,01; p<0,01, OR 6,56), acute kidney injury (88,9% vs 56,52%; x</span></span></span><span style="font-size:10.5pt"><span style="font-family:Symbol"><span style="color:black"><sup>2</sup></span></span></span><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">= 6; p=0,02; OR =6,15) and higher admission creatinine (p=0,02). </span></span></span></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Patients with ShH were associated with a significant higher IHM and presenting 4,7 times higher likelihood of IHM compared with ShLM (36% vs 11%; x</span></span></span><span style="font-size:10.5pt"><span style="font-family:Symbol"><span style="color:black"><sup>2</sup></span></span></span><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">= 5,418; p=0,02; OR =4,71). Patients with SSH had a 5,6 times higher likelihood of IHM compared with SSL (50% vs 15,2%; x</span></span></span><span style="font-size:10.5pt"><span style="font-family:Symbol"><span style="color:black"><sup>2</sup></span></span></span><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">= 8,348; p=0,01; OR =5,57). When comparing ShS and SS they were statistically significative and similar in predicting IHM (AUC 0,712, p=0,01 vs AUC 0,745, p=0,01, respectively). </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Conclusion: </span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">In our population both scores performed equally well at identifying patients with increased risk of IHM. Both scores are adequate at predicting higher risk of adverse outcomes.</span></span></span></span></span></p>
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