The VIRSTA score demonstrated high sensitivity (96.7%) and NPV (99.5%) for predicting infective endocarditis in Staphylococcus aureus bacteremia, outperforming the PREDICT score (AUC 0.86 vs 0.64).
Cohort (n=922)
Yes
Can the VIRSTA and PREDICT scores accurately predict the risk of infective endocarditis and determine the need for echocardiography in patients with Staphylococcus aureus bacteremia?
The VIRSTA score is a highly sensitive tool with excellent negative predictive value that can safely identify patients with Staphylococcus aureus bacteremia who may not require screening echocardiography for infective endocarditis.
BACKGROUND: Infective endocarditis (IE) secondary to Staphylococcus aureus bacteremia (SAB) has high morbidity and mortality. The systematic use of echocardiography in SAB is controversial. We aimed to validate VIRSTA and Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT) scores for predicting the risk of IE in Colombian patients with SAB and, consequently, to determine the need for echocardiography. METHODS: Cohort of patients hospitalized with SAB in 2 high complexity institutions in Medellin, Colombia, between 2012 and 2018. The diagnosis of IE was established based on the modified Duke criteria. The VIRSTA and PREDICT scores were calculated from the clinical records, and their operational performance was calculated. RESULTS: The final analysis included 922 patients, 62 (6.7%) of whom were diagnosed with IE. The frequency of IE in patients with a negative VIRSTA scale was 0.44% (2/454). The frequency of IE in patients with a negative PREDICT scale on day 5 was 4.8% (30/622). The sensitivity and negative predictive value (NPV) of the VIRSTA scale was 96.7% and 99.5%, respectively. For the PREDICT scale on day 5, the sensitivity and NPV were 51.6% and 95.1%, respectively. The discrimination, given by the area under the receiver operating characteristic curve, was 0.86 for VIRSTA and 0.64 for PREDICT. CONCLUSIONS: In patients with negative VIRSTA, screening echocardiography may be unnecessary because of the low frequency of IE. In PREDICT-negative patients, despite the low frequency of IE, it is not safe to omit echocardiography.
Peinado-Acevedo et al. (Thu,) conducted a cohort in Staphylococcus aureus bacteremia (n=922). VIRSTA and PREDICT scores was evaluated on Diagnosis of infective endocarditis based on modified Duke criteria. The VIRSTA score demonstrated high sensitivity (96.7%) and NPV (99.5%) for predicting infective endocarditis in Staphylococcus aureus bacteremia, outperforming the PREDICT score (AUC 0.86 vs 0.64).
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