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Internal and external validation of a model to predict adverse outcomes in patients with left-sided infective endocarditis
  1. Javier López1,
  2. Nuria Fernández-Hidalgo2,
  3. Ana Revilla1,
  4. Isidre Vilacosta3,
  5. Pilar Tornos2,
  6. Benito Almirante2,
  7. Teresa Sevilla1,
  8. Itziar Gómez1,
  9. Eduardo Pozo3,
  10. Cristina Sarriá4,
  11. José Alberto San Román1
  1. 1Institute of Heart Sciences (ICICOR), University Clinic Hospital, Valladolid, Spain
  2. 2Hospital Universitari Vall d'Hebron, Barcelona, Spain
  3. 3University Hospital San Carlos, Madrid, Spain
  4. 4Hospital la Princesa, Madrid, Spain
  1. Correspondence to Dr Javier López Díaz, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, C/ Ramón y Cajal 3, 47005 Valladolid, Spain; javihouston{at}


Introduction Early identification of prognostic factors is essential to improve the grim prognosis associated with left-sided infective endocarditis. This group identified three independent risk factors obtained within 72 h of admission, (Staphylococcus aureus, heart failure and periannular complications) for inhospital mortality or urgent surgery in a series of 317 patients diagnosed at five tertiary centres (derivation sample). A stratification score was constructed for the test cohort by a simple arithmetic sum of the number of variables present. The goal was to validate this model internally and externally in a prospective manner with two different cohorts of patients.

Methods The appropriateness of the model was tested prospectively on predicting events in two cohorts of patients with left-sided endocarditis: internally with the 263 consecutive patients diagnosed at the same centres where the model was derived (internal validation sample), and externally with 264 patients admitted at another hospital (external validation sample).

Results The discriminatory power of the model, expressed as the area under the receiver operating characteristic curve was similar between derivation and both validation samples (internal 0.67 vs 0.68, p=0.79; external 0.67 vs p=0.74, p=0.09). There was a progressive, significant pattern of increasing event rates as the risk stratification score increased in both validation cohorts (p<0.001 by χ2 for trend).

Conclusions The early risk stratification model derived, based on variables obtained within 72 h of admission, is applicable to different populations with left-sided endocarditis. A simple bedside assessment tool is provided to clinicians that identifies patients at high risk of having an adverse event.

  • Endocardial disease
  • endocarditis
  • prognosis stratification
  • risk score

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  • See Editorial, p 1117

  • Linked article 218578.

  • Funding This study was financed in part by the Cooperative Network for Cardiovascular Research (Red Cooperativa de Enfermedades Cardiovasculares, RECAVA) of the Spanish National Institute of Health (Instituto de Salud Carlos III). BA and NFH belong to the Spanish Network for Research in Infectious Diseases (REIPI RD06/0008).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the ethical committees of all the participing centres.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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