SHARPEN score: an independent predictor of survival after infective endocarditis discharge

Background

Infective endocarditis (IE) presents high mortality even in patients that were adequately treated. Proper identification of these patients is imperative for better care delivery. SHARPEN score (Systolic BP, Heart failure, Age, Renal function, Pneumonia, Elevated peak CRP, and Non-intravenous drug abusers) was validated to predict in-hospital mortality due to IE; its performance in predicting survival after hospital discharge, however, has not yet been evaluated.

Purpose

To assess the SHARPEN score in predicting survival after hospital discharge due to IE.

Methods

Retrospective cohort study including all patients ≥18 years discharged after definitive IE (modified Duke criteria) admission at a public tertiary teaching hospital in southern Brazil, between 2000–16. Only the first hospitalization for IE was considered in those patients with >1 admission for that reason in the studied period. The SHARPEN score was calculated at admission, and each patient was classified as low-moderate (2–10 points) or high (11–20 points) risk. Follow-up was carried out through the review of medical records, and the assessed outcome was death by any cause. Survival analysis was performed using the Kaplan-Meier curves, which were compared using the Log-rank test.

Results

A total of 135 patients (mean age: 53±17 years, 97 [72%] male) were discharged after IE episode. Staphylococcus aureus was the main etiologic agent (29 [21.5%]), and cardiac surgery was performed in 54 (40%) patients. The median SHARPEN score was 9 (IQR: 7–11 points), being classified as low-moderate risk (96 [71%]) and high risk (39 [29%]) patients, respectively. Median post-discharge follow-up was 3.4 (IQR: 0.19–9) years (682 patient-years), with 37 deaths during the period. Mean post-discharge survival was 12.4 years (95% CI: 10.7–14), significantly higher in patients classified as low-moderate risk (13.7 years) in comparison to high risk (8.4 years) (Log-rank P=0.006; Figure).

Conclusion

Patients classified as high-risk by SHARPEN score during IE admission present significantly higher mortality after discharge, despite being effectively treated for the IE episode. SHARPEN score could also be used to assess morbimortality after discharge, helping to implement special care programs for high-risk patients.

Funding Acknowledgement

Type of funding sources: None.

Persistent pulmonary congestion before discharge predicts rehospitalization in heart failure: a lung ultrasound study

Background

B-lines evaluated by lung ultrasound (LUS) are the sonographic sign of pulmonary congestion, a major predictor of morbidity and mortality in patients with heart failure (HF). Our aim was to assess the prognostic value of B-lines at discharge to predict rehospitalization at 6 months in patients with acute HF (AHF).

Methods

A prospective cohort of 100 patients admitted to a Cardiology Department for dyspnea and/or clinical suspicion of AHF were enrolled (mean age 70 ± 11 years). B-lines were evaluated at admission and before discharge. Subjects were followed-up for 6-months after discharge.

Results

Mean B-lines at admission was 48 ± 48 with a statistically significant reduction before discharge (20 ± 23, p < .0001). During follow-up, 14 patients were rehospitalized for decompensated HF. The 6-month event-free survival was highest in patients with less B-lines (≤ 15) and lowest in patients with more B-lines (> 15) (log rank χ² 20.5, p < .0001). On multivariable analysis, B-lines > 15 before discharge (hazard ratio [HR] 11.74; 95 % confidence interval [CI] 1.30–106.16) was an independent predictor of events at 6 months.

Conclusions

Persistent pulmonary congestion before discharge evaluated by ultrasound strongly predicts rehospitalization for HF at 6-months. Absence or a mild degree of B-lines identify a subgroup at extremely low risk to be readmitted for HF decompensation.