Routine urinalysis for early clinical assessment in patients with vegetation-like echocardiographic findings

Background Incidental vegetation-like findings on echocardiography prompt extensive diagnostic evaluation for infective endocarditis (IE), even in patients with low clinical suspicion. Given the association between IE and renal involvement, we evaluated whether routine urinalysis could serve as a simple adjunctive tool to aid early clinical assessment in this setting. Methods We retrospectively analyzed adults with vegetation-like echocardiographic findings at a tertiary center between 2010 and 2024. Patients were classified as those with confirmed IE [IE (+)] and those in whom IE was ultimately excluded [IE (–)]. Urinalysis parameters at presentation were analyzed, and a simple additive score was constructed. Results A total of 459 patients were included, comprising 202 with IE (+) and 257 with IE (–). Proteinuria, hematuria, and pyuria were more frequent in IE (+) and remained independently associated with IE in multivariable analysis. An additive score incorporating these variables (1 point each; range 0–3) demonstrated acceptable discriminatory ability (area under the curve, 0.77; 95% CI, 0.72–0.81). A score of 0 showed a relatively high sensitivity (78%) with acceptable specificity (67%). Conclusions The absence of hematuria, proteinuria, and pyuria on routine urinalysis may serve as a supportive adjunct—not a rule-out test—for early clinical assessment.