ArticleJournal of clinical medicine2022
Unreliability of Clinical Prediction Rules to Exclude without Echocardiography Infective Endocarditis in
Article in Journal of clinical medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed, 9 citations in OpenAlex.
- Validation of the VIRSTA and VIRSTA+ Scores to Identify Patients with Staphylococcus aureus Bacteremia at Very Low Risk of Infective Endocarditis.Infectious diseases and therapy · 2026Article
- A comparative analysis between transthoracic and transesophageal echocardiography in screening for infective endocarditis in patients withProceedings (Baylor University. Medical Center) · 2025Article
- Unexpected Infective Endocarditis: Towards a New Alert for Clinicians.Journal of clinical medicine · 2024Review
- Risk of endocarditis among patients with coagulase-negative Staphylococcus bacteremia.Scientific reports · 2023Article
- The Changing Complementary Role of Multimodality Imaging in Clinical Cardiology.Journal of clinical medicine · 2022Article
- The LAUsanneFrontiers in cardiovascular medicine · 2022Article
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Authors and funding
11 authors at 1 institution in 1 country.
Funding
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Abstract
backgroundIt is unclear whether the use of clinical prediction rules is sufficient to rule out infective endocarditis (IE) in patients with
methodsWe conducted a unicentric retrospective cohort including all patients with a first SAB episode from January 2015 to December 2020. IE was defined according to modified Duke criteria. We predefined threshold cutoff points to consider that IE was ruled out by means of the mentioned scores. To assess 30-day mortality, we used a multivariable regression model considering performing an echocardiogram as covariate.
resultsOut of 404 patients, IE was diagnosed in 50 (12.4%). Prevalence of IE within patients with negative PREDICT, POSITIVE, and VIRSTA scores was: 3.6% (95% CI 0.1-6.9%), 4.9% (95% CI 2.2-7.7%), and 2.2% (95% CI 0.2-4.3%), respectively. Patients with negative VIRSTA and negative TTE had an IE prevalence of 0.9% (95% CI 0-2.8%). Performing an echocardiogram was independently associated with lower 30-day mortality (OR 0.24 95% CI 0.10-0.54,
conclusionPREDICT and POSITIVE scores were not sufficient to rule out IE without TEE. In patients with negative VIRSTA score, it was doubtful if IE could be discarded with a negative TTE. Not performing an echocardiogram was associated with worse outcomes, which might be related to presence of occult IE. Further studies are needed to assess the usefulness of clinical prediction rules in avoiding echocardiographic evaluation in SAB patients.
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