To develop a multimarker prognostic score for infective endocarditis (IE).
Secondary care. Single centre.
125 patients with definite IE.
Primary outcome measures
90-day and 5-year mortality.
Mean age was 62.7±17 years. The 90-day and 5-year mortality was 10.4% and 33.6%, respectively. CysC levels at admission and over 20% increases in CysC levels during 2 weeks of treatment were prognostic for 90-day and 5-year mortality independent of creatinine estimated glomerular filtration rate. In multivariate analyses, CysC (OR 5.42, 95% CI 1.90 to 15.5, p=0.002) and age (OR 1.06, 95% CI 1.02 to 1.10, p=0.002) remained prognostic for 5-year mortality. NT-proBNP, TnT, C reactive protein and interleukin 6 were also linked to prognosis. A composite risk scoring system using levels of CysC, NT-proBNP, age and presence of mitral valve insufficiency was able to separate a high-risk and a low-risk group.
CysC levels at admission and increase in CysC after 2 weeks of treatment were independent prognostic markers for both 90-day and 5-year mortality in patients with IE. A multimarker composite risk scoring system including CysC identified a high-risk group.
Our aim was to develop a multimarker prognostic score for IE.
CysC levels at admission and increase in CysC after 2 weeks of treatment were independent prognostic markers for both 90-day and 5-year mortality in patients with IE.
A prognostic score including CysC over 1.2 mg/l, NT-ProBNP over 2000 ng/l, presence of any grade of mitral valve insufficiency (MI) and aged 70 years or older could identify a high-risk and low-risk group in IE.
The prognostic score might be used to improve patient monitoring and assist treatment choices in IE.
Strengths and limitations of this study
We were able to monitor changes in levels of biomarkers during treatment in a large cohort of IE patients since blood samples were collected at admission and after 2 weeks of treatment.
One potential weakness was that 36.2% of patients treated for IE during the study period (71/196) were unavailable for biomarker studies since they lacked stored blood samples. The mortality was lower in the study group (125) compared with all IE patients treated for IE (196) during the study period.