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JAC Advance Access originally published online on October 24, 2008
Journal of Antimicrobial Chemotherapy 2008 62(6):1434-1440; doi:10.1093/jac/dkn423
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
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Original research

Development and assessment of a new early scoring system using non-specific clinical signs and biological results to identify children and adult patients with a high probability of infective endocarditis on admission

Hervé Richet1, Jean-Paul Casalta1, Franck Thuny2, Julien Mérrien1, Jean-Robert Harlé3, Pierre-Jean Weiller4, Gilbert Habib2 and Didier Raoult1,*

1 Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France 2 Department of Cardiology, Hôpital de la Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France 3 Service of Internal Medicine, Hôpital de la Conception, 147 Boulevard Baille, 13385 Marseille Cedex 05, France 4 Service of Internal Medicine, Hôpital de la Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France

Received 8 July 2008; returned 6 August 2008; revised 5 September 2008; accepted 14 September 2008

* Corresponding author. Tel: +33-4-91-32-44-80; Fax: +33-4-91-38-77-72; E-mail: Didier.Raoult{at}gmail.com

Objectives: The aim of this study was to assess whether non-specific clinical signs or biological results can identify patients with a high probability of infective endocarditis (IE) to improve outcome.

Patients and methods: All patients tested for IE were included in a cohort and classified according to the modified Duke criteria. Patients with rejected endocarditis served as controls. Univariate and multivariate analyses were performed, and a score was calculated by adding 1 when a variable independently associated with IE (excluding major Duke criteria) was present and 0 when the variable was absent. A second score for patients with prior valvular damage (PVD) was also used. Scores were evaluated using the ROC curve method.

Results: IE was diagnosed in 402 of 2039 participants (19.7%). By multivariate analysis, PVD, fever, emboli, stroke, splenomegaly, finger clubbing, leucocytosis and erythrocyte sediment rate >50 were independently associated with IE. The rate of IE increased significantly from 4% (10/254) for a score of 0 to 83% (10/12) for a score of 6 in all patients, and from 9.5% (23/241) to 100% (10/10) in patients with PVD. The area under the ROC curve was 0.75 for the first score and 0.7 for the second. In a prospective study of 117 patients with suspicion of IE, the proportion of confirmed IE was 19% and the area under the ROC curve was 0.72.

Conclusions: This simple score can be used to identify patients with a high probability of IE, in the emergency room or on admission, to speed up diagnosis, or to initiate empirical antimicrobial therapy without replacing the modified Duke criteria.

Keywords: treatment , diagnosis , IE


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