Age-Creatinine-Ejection Fraction Score in Infective Endocarditis: Integrated Clinical and Echocardiographic Score for Surgically and Medically Treated Patients

Background: Infective endocarditis (IE) is associated with high morbidity, therefore the identification of high risk patients is crucial. Age-creatinine-ejection fraction (ACEF) score is a risk stratification tool already used in different clinical settings. The aims of our study is to evaluate its ability to identify IE patients with worst prognosis. Methods: Consecutive patients hospitalized in our infectious diseases hospital for IE were retrospectively included (January 2023 - February 2025). Clinical, laboratory, echocardiographic data and ACEF score were recorded at admission. Results: One hundred forty-three patients were included. Mean age was 65±14 years (69% males). Native valve was involved in 48% and Staphylococcus aureus was responsible in 16% patients. Thirty patients died during follow up. At adjusted Cox regression model, higher ACEF score (AdjHR= 2.944; CI 1.153-7.513; p= 0.024), diabetes mellitus (AdjHR= 4.842; CI 1.017-4.322; p 0.022), cardiac surgery indicated but not performed (AdjHR 5.695; CI 1.503-21.574; p= 0.010) and Staphylococcus aureus infection (AdjHR 1.058; CI 1.012-1.280; p <0.001) were associated with worst outcome. In Kaplan-Meier analysis, these populations had significantly higher in-hospital and early mortality (P-log-rank= 0.024; 0.022; 0.010 and <0.001). Conclusions: ACEF score is a simple risk score, integrating clinical and echocardiographic informations, that can be easily calculated in IE. High ACEF score ≥1.30 was associated to worst prognosis in terms of higher mortality during follow up, in both surgically or medically treated subjects. Our results suggest the possible use of ACEF score to stratify risk in newly diagnosed IE, representing a quick tool for clinicians in everyday practice.