Accuracy and Prognosis Value of the Sequential Organ Failure Assessment Score Combined With C-Reactive Protein in Patients With Complicated Infective Endocarditis.

Yaowang Lin,Weijie Bei,Shaohong Dong,Ruimian Chen,Danqing Yu,Haiyan Qin,Jie Yuan

doi:10.3389/fmed.2021.576970

Abstract

This study aimed to evaluate the accuracy and prognostic value of the sequential organ failure assessment (SOFA) score combined with C-reactive protein (CRP) in patients with complicated infective endocarditis (IE). A total of 246 consecutive patients with complicated IE were included in the multicentric prospective observational study. These patients were divided into four groups depending on the SOFA score and CRP optimal cutoff values (≥5 points and ≥17.6 mg/L, respectively), which were determined using the receiver operating characteristic analysis: low SOFA and low CRP (n = 83), low SOFA and high CRP (n = 87), high SOFA and low CRP (n = 25), and high SOFA and high CRP (n = 51). The primary endpoint was in-hospital death, and the secondary endpoint was long-time mortality, defined as subsequent readmission and 3-years mortality in the follow-up period. High SOFA score and high CRP were associated with approximately 29.410% (15/51) of higher incidence of in-hospital death with an area under the curve of 0.872. Multivariate analyses showed that age [odds ratio (OR) = 2.242, 1.142–4.401], neurological failure (Glasgow Coma Scale ≤ 12) (OR = 2.513, 1.041–4.224), Staphylococcus aureus (OR = 2.151, 1.252–4.513), SOFA ≥ 5 (OR = 9.320, 3.621–16.847), and surgical treatment (OR = 0.121, 0.031–0.342) were clinical predictors for in-hospital death. On following up for 12–36 months, SOFA ≥ 5 (p = 0.000) showed higher mortality. A high SOFA score combined with increased CRP levels is associated with in-hospital mortality. Also, SOFA score, but not CRP, predicts long-term mortality in complicated IE.

Highlights

Infective endocarditis (IE) causes nearly 20% of in-hospital mortality, 17% of 30-days mortality, 30% of 1-year mortality, and up to 40% mortality at 5-years follow-up, posing a diagnostic and therapeutic challenge to clinicians [1, 2]
Patients were divided into four groups based on the sequential organ failure assessment (SOFA) score (≥5 points) and C-reactive protein (CRP) level (≥17.6 mg/L) cutoff values: low SOFA and low CRP (n = 83), high SOFA and low CRP (n = 25), low SOFA and high CRP (n = 87), and high SOFA and high CRP (n = 51)
Patients with a high SOFA score and a high CRP level were associated with higher incidence of diabetes mellitus (9.8 vs. 3.45% vs. 0 vs. 0, p = 0.005), Staphylococcus aureus (27.45 vs. 9.20 vs. 12.0 vs. 2.41%, p = 0.001), stroke (27.45 vs. 16% vs. 8.05 vs. 1.2, p = 0.000), vegetation size ≥ 10 mm (56.86 vs. 47.13 vs. 44 vs. 29.63%, p = 0.014), in-hospital death (29.41 vs. 12 vs. 2.47 vs. 1.15%, p < 0.000), and long-time mortality (15.69 vs. 8 vs. 6.9 vs. 0%, p < 0.000)

Summary

Introduction

Infective endocarditis (IE) causes nearly 20% of in-hospital mortality, 17% of 30-days mortality, 30% of 1-year mortality, and up to 40% mortality at 5-years follow-up, posing a diagnostic and therapeutic challenge to clinicians [1, 2]. Early identification of patients at high risk of death or complications is essential to improve the outcome of this disease. Research works have shown the sequential organ failure assessment (SOFA) score and C-reactive protein (CRP) to be effective prognostic tools in the management of sepsis, infections as well as patients with IE [3,4,5]. Studies regarding the combined effect of SOFA and CRP on predicting adverse outcomes in patients with complicated IE remain unknown.

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