The VIRSTA score, a prediction score to estimate risk of infective endocarditis and determine priority for echocardiography in patients with Staphylococcus aureus bacteremia - 14/04/16
, François Alla c, d, e, Christine Selton-Suty f, Pierre Tattevin g, François Delahaye h, Lionel Piroth i, Catherine Chirouze j, Jean-Philippe Lavigne k, Marie-Line Erpelding d, f, Bruno Hoen l, m, François Vandenesch n, Bernard Iung o, p, Vincent Le Moing qthe VIRSTA/AEPEI Study Group
Summary |
Objectives |
To develop and validate a prediction score, to quantify, within 48 h of Staphylococcus aureus bacteremia (SAB) diagnosis, the risk of IE, and therefore determine priority for urgent echocardiography.
Methods |
Consecutive adult patients with SAB in 8 French university hospitals between 2009 and 2011 were prospectively enrolled and followed-up 3 months. A predictive model was developed and internally validated using bootstrap procedures.
Results |
Among the 2008 patients enrolled, 221 (11.0%) had definite IE of whom 39 (17.6%) underwent valve surgery, 25% of them within 6 days of SAB diagnosis. Ten predictors independently associated with IE were used to build up the prediction score: intracardiac device or previous IE, native valve disease, intravenous drug use, community or non-nosocomial-acquisition, cerebral or extracerebral emboli, vertebral osteomyelitis, severe sepsis, meningitis, C-reactive protein above 190 mg/L, and H48-persistent bacteremia. Patients with a score ≤2 (n = 792, 39.4%) were at low IE-risk (1.1%; negative predictive value: 98.8% (95% CI, 98.4–99.4)) compared to those ≥3 who were at higher risk (17.4%).
Conclusions |
Physicians must be strongly encouraged to urgently perform echocardiography in SAB patients with a score ≥3 to establish IE diagnosis, to orient antimicrobial therapy and to help determine the need for valvular surgery.
Le texte complet de cet article est disponible en PDF.Keywords : Staphylococcus aureus bacteremia, Infective endocarditis, Prognostic score, Echocardiography, VIRSTA score
Abbreviations : CI, CRP, ICD, IE, IQR, SAB, S. aureus, TEE, TTE
Plan
Vol 72 - N° 5
P. 544-553 - mai 2016 Retour au numéro
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