Sharpen Score Accurately Predict In-Hospital Mortality In Infective Endocarditis: A Real-World Validation Study

Abstract Background Infective Endocarditis (IE) has impressive 30-day mortality of up to 30%. Prompt recognition of high-risk patients is required in order to optimize management and outcomes. The SHARPEN score was recently developed to predict intrahospital mortality in patients admitted due to IE, regardless of the need to undergo cardiac surgery. We aimed to evaluate the accuracy of the SHARPEN score to predict in-hospital mortality in comparison to Charlson Comorbidity Index (CCI). Methods Retrospective cohort of all consecutive adult admissions between 2000 and 2016 with diagnosis of definitive IE according to the Modified Duke Criteria. The SHARPEN score was applied comprising: Systolic blood pressure at presentation, Heart failure, Age, Raised creatinine, Pneumonia, Elevated peak CRP and Non-intravenous drug abuser. The CCI was applied to assess comorbidities. Accuracy in predict mortality was estimated with C-statistic. DeLong test was used to compare the areas under the curve (AUC). Survival probabilities were estimated by Kaplan-Meier method and differences between survival curves analyzed using the log-rank test. Multivariate analysis using Poisson Regression with robust variation was performed to determine independent predictors of in-hospital mortality. Results 179 cases of IE were registered (70% male; 55±17 years-old) with an in-hospital mortality of 22%. Cardiac surgery was required in 68 (38%) of the patients. Calculated SHARPEM and CCI scores were 9 (7–11) and 3 (1–6) points respectively. SHARPEN was able to predict in-hospital mortality with an AUC of 0.76 (95% CI 0.7–0.8; p<0.001) and cut-off >10 points (Sen=69%; Sp=71%; PPV=40%; NPV=89%). Mortality was significant higher (40% vs 11%; p<0.001) in patients with SHARPEN >10 points (FIGURE). CCI had a similar AUC of 0.7 (95% CI 0.6 - 0.8; p<0.001) with SHARPEN (p=0.32). However, in a multivariate analysis, SHARPEN score >10 points a stronger predictor related with in-hospital mortality (OR 2.3; 95% CI 1.1 - 4.8; p=0.03) in comparison to CCI >3 points (OR 1.4; 95% CI 0.7–2.8; p=0.3). Conclusion SHARPEN score demonstrated a good accuracy in predict in-hospital mortality independently of other variables, with a high negative predictive value. These findings suggest that SHARPEN score may be useful to stratify high-risk IE patients in a clinical setting. Funding Acknowledgement Type of funding source: None