Abstract Introduction 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. Purpose 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. Methods 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. Results 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. 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). Conclusions 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.
Silva et al. (Sat,) studied this question.