Abstract Introduction and Objective: Early identification of patients with infective endocarditis (IE) at higher risk is a necessary step to improve the prognosis of this disease. The CHA2DS2-VASc score, originally designed to assess the risk of thromboembolic events in atrial fibrillation, could help identify patients with higher mortality and embolic events in left-sided infectious endocarditis. The objective of this study is to analyze whether the newest approved CHA2DS2-VA score is a predictor of in-hospital mortality and embolic events in patients with definitive left-sided IE. Methods: Every patient with a final diagnosis of definite left-side IE (LSIE) admitted to three tertiary hospitals in Europe treated between 1996 to 2023 was included in an ongoing multipurpose database. Modified Duke criteria we applied for inclusion criteria. CHA2DS2-VA score at admission for each patient was reviewed and calculated for all patients, regardless of AF history. The two primary endpoints were: 1) in-hospital mortality and 2) symtomatic embolic events (EE) developed during hospitalization and before valve surgery if it was performed. The study protocol was approved by local ethic committee of our hospitals. Results: The score was calculated in 1,420 patients (94.6% of the series). Mean age was 64.5 ± 13.7 years and 66% were men. In-hospital mortality occurred in 28.8% of patients and 27.5% experienced EE. 43% of patients had a score of 2 or less. There were significant differences in mortality based on the score (p 0.001). We calculated the best cut-off point with the highest sensitivity and specificity as a predictor of in-hospital mortality in patients with LSIE. The analysis showed that CHA2DS2-VA score 2 was the best predictor of mortality. We also considered in-hospital mortality based on this score in patients with and without history of AF. In both groups mortality rates were superior with higher CHA2DS2-VA score. To determine potential variables independently associated with LSIE mortality, a multivariate analysis was also performed. We included in the model variables that were significant and clinically relevant in the univariate analysis previously calculated. Prognostic factors of mortality are shown in "Abstract Pictures". Of note, CHA2DS2-VA score was independently associated with in-hospital mortality (OR 1.612; IC 95% (1.232-2.109)). However, this score does not predict EE in LSIE (p = 0.590). Conclusions: Patients with LSIE, CHA2DS2-VA score identifies patients with poor in hospital outcome and might be used in the risk stratification process, but it is not useful to predict EE.Multivariant analysis of mortality Distribution of mortality
Orive et al. (Sat,) studied this question.