Risk prediction in infective endocarditis by modified MELD-XI score

• Published in: European journal of clinical microbiology & infectious diseases Vol. 37; no. 7; pp. 1243 - 1250
• Main Authors: He, Peng-cheng, Wei, Xue-biao, Luo, Si-ni, Chen, Xiao-lan, Ke, Zu-hui, Yu, Dan-qing, Chen, Ji-yan, Liu, Yuan-hui, Tan, Ning
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2018; Springer Nature B.V
• Subjects: Adult; Biomedical and Life Sciences; Biomedicine; C-reactive protein; C-Reactive Protein - analysis; End Stage Liver Disease - diagnosis; Endocarditis; Endocarditis, Bacterial - diagnosis; Endocarditis, Bacterial - mortality; Female; Humans; Internal Medicine; Liver; Liver diseases; Male; Medical Microbiology; Middle Aged; Mortality; Multivariate analysis; Original Article; Patients; Predictions; Prognosis; Risk analysis; Risk assessment; Risk Factors; Severity of Illness Index; Surgical instruments; Infective endocarditis; Risk score; Prognosis
• DOI: 10.1007/s10096-018-3240-8
• ISSN: 0934-9723; 1435-4373

The suitability of the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score to predict adverse outcomes in infective endocarditis (IE) patients remains uncertain. This study was performed to explore the prognostic value of the MELD-XI score and modified MELD-XI score for patients with IE. A total of 858 patients with IE were consecutively enrolled and classified into two groups: MELD-XI ≤ 10 ( n  = 588) and MELD-XI > 10 ( n  = 270). Multivariate analysis was performed to determine risk factors independent of MELD-XI score. Higher MELD-XI score was associated with higher in-hospital mortality (15.6 vs. 4.8%, p  < 0.001) and major adverse clinical events (33.3 vs. 18.4%, p  < 0.001). MELD-XI score was an independent predictor of in-hospital death (odds ratio [OR] = 1.06, 95% CI, 1.02–1.10, p  = 0.005). Based on a multivariate analysis, NYHA class III or IV (3 points), C-reactive protein > 9.5 mg/L (4 points), and non-surgical treatment (6 points) were added to MELD-XI score. Modified MELD-XI score produced higher predictive power than previous (AUC 0.823 vs. 0.701, p  < 0.001). The cumulative incidence of long-term mortality (median 29 months) was significantly higher in patients with modified MELD-XI score > 13 than those without (log-rank = 25.30, p  < 0.001). Modified MELD-XI score was independently associated with long-term mortality (hazard ratio = 1.08, 95% CI, 1.04–1.12, p  < 0.001). MELD-XI score could be used as a risk assessment tool in IE. Furthermore, modified MELD-XI score remained simple and more effective in predicting poor prognosis.