Abstract
Aim
Infective endocarditis (IE) can be life‐threatening because of various associated adverse events. The quick Sepsis‐related Organ Failure Assessment (qSOFA) score is a straightforward useful method for predicting in‐hospital mortality in patients with suspected infections. However, few data exist regarding the clinical impact of the qSOFA score on predicting adverse events in IE during hospitalization. We studied the usefulness of qSOFA score for predicting in‐hospital adverse events in patients with IE.
Methods
We retrospectively analyzed 104 consecutive patients diagnosed with IE on the basis of modified Duke criteria. We defined in‐hospital adverse events as occurrence of any of the following events during hospitalization: death, embolism, hemorrhage, or abscess formation. The high qSOFA group was defined as those with a qSOFA score ≥2. We used Cox regression analysis to estimate the hazard ratio for high qSOFA score on in‐hospital adverse events adjusted for age, sex, and Staphylococcus aureus infection.
Results
We analyzed 83 patients (57 men, mean age 61 ± 18 years) from the total cohort of 104 patients enrolled. Among these, 12 (14.5%) had high qSOFA scores. The high qSOFA group had higher in‐hospital mortality compared to the low qSOFA group (50.0% vs. 4.2%, P < 0.01). In the Cox proportional hazards model, high qSOFA was significantly associated with in‐hospital adverse events (adjusted hazard ratio, 2.29; confidence interval, 1.02–5.12; P = 0.044).
Conclusion
These results showed that high qSOFA score was significantly associated with in‐hospital adverse events in IE patients, although further prospective study is necessary to confirm our results.
Keywords: Infective endocarditis, in‐hospital, quick SOFA score, risk factor
Introduction
Infective endocarditis (IE) is an infection of endocardium, usually of heart valves, and can be life‐threatening because of persistent bacteremia and various adverse events that occur during hospitalization. In‐hospital mortality of patients presenting with IE is currently 18–26%.1, 2, 3 In addition, in‐hospital adverse events such as embolism, abscess formation, intracranial hemorrhage, and cardiac complications account for up to 50% of cases.4 Embolism is especially common, and occurs in approximately 44% of patients with IE.5, 6 Moreover, embolic complication is a predictor of in‐hospital death due to IE.7 Several studies have reported risk factors for death or complications in IE patients, including age, infection with Staphylococcus aureus, large vegetation (≥10 mm), and prosthetic valve IE.2, 3, 8, 9, 10, 11, 12, 13, 14 In the 2015 European Society of Cardiology Guidelines for the management of infective endocarditis, the predictors of poor outcome in patients with IE are classified by four components: patient characteristics, clinical complications of IE, microorganism, and echocardiographic findings.15 However, in‐hospital mortality and adverse event rates have still been high (20.7% and 29.5%, respectively, mortality at 30 days after admission and embolic events) in patients with IE despite using these conventional risk factors.16 Therefore, novel risk factor would be needed to more efficiently predict in‐hospital adverse events in IE patients.
Recently, Sepsis‐related Organ Failure Assessment (SOFA) score has been reported to be useful for predicting in‐hospital mortality and organ dysfunction among patients with suspected infection.17, 18 Moreover, the quick SOFA (qSOFA) score, a simplified version of the SOFA score, can more accurately identify patients at high risk of in‐hospital mortality due to suspected infections in non‐intensive care unit (ICU) patients.19, 20, 21 The most important advantage of the qSOFA score is its simplicity in predicting in‐hospital adverse events. Furthermore, as we can evaluate the qSOFA score using only three vital signs, this can contribute to rapid stratification of in‐hospital risks in primary medical settings. However, few data exist regarding the clinical impact of qSOFA score on predicting adverse events in IE patients during hospitalization. Therefore, we evaluated whether the qSOFA score could predict future in‐hospital adverse events in patients with IE.
Methods
Study participants
This retrospective cohort study was approved by the Institutional Review Board of Kanazawa University Hospital (Kanazawa, Japan). We retrospectively enrolled IE patients hospitalized in Kanazawa University Hospital from January 2006 to February 2017. Infective endocarditis was diagnosed based on modified Duke criteria.22 We collected basic characteristics of patients from medical records, including age, gender, predisposing cardiac disease, coexisting disease, echocardiographic findings, causative microorganism, and complications during hospitalization. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, or receiving antihypertensive medication. Diabetes mellitus was defined as glycosylated hemoglobin ≥6.5% or receiving antidiabetic medication. Dyslipidemia was defined as total cholesterol >220 mg/dL or receiving medication for dyslipidemia. Chronic kidney disease was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2.
We defined steroids, cyclosporine, and chemotherapeutic agents as immunosuppressive agents. We checked for the presence of dental infection by treatment history or dental examination. Left ventricular ejection fraction was measured by the Teichholz method. Blood cultures were deemed positive when microorganisms were detected from two or more separate blood cultures.
Quick SOFA score calculation
Quick SOFA scores were rated on a scale of 0, 1, 2, 3 (1 point each added for systolic hypotension [≤100 mmHg], tachypnea [≥22/min], or altered mentation [Glasgow Coma Scale <15]).23 We evaluated each qSOFA score by their vital signs at admission. The high qSOFA group consisted of patients with qSOFA score ≥2.
Study end‐points
Primary outcome was a composite of in‐hospital adverse events, defined as occurrence of any of the following events during hospitalization: all‐cause death, embolism, intracranial hemorrhage, or abscess formation. These complications would be fatal or could often cause serious physical disability over a long period in IE patients. Complications were diagnosed by imaging studies (computed tomography or magnetic resonance imaging) regardless of symptoms.
Statistical analysis
Continuous variables are presented as mean ± standard deviation or median (interquartile range) for continuous variables according to their distribution, and as numbers (percentages) for categorical variables. We compared two variables by t‐test or Mann–Whitney U‐test for continuous variables according to their distributions, and Fisher's exact test for categorical variables. We used the Kaplan–Meier method and log–rank test for estimation of cumulative incidence and differences between groups, respectively. We used the Cox proportional hazard model to estimate hazard ratios for in‐hospital adverse events adjusted for age, sex, and variables significantly associated with the composite events by univariate analysis. We used R version 3.1.1 (R Foundation for Statistical Computing, Vienna, Austria) for statistical analyses. All P‐values of tests were two‐tailed and P‐values <0.05 were considered statistically significant.
Results
Baseline characteristics
Among 104 IE patients enrolled, 21 were excluded due to incomplete availability of data for qSOFA score calculation. Eighty‐three patients (57 men, mean age 61 ± 18 years) were finally enrolled for further analyses. Baseline characteristics of IE patients are summarized in Table 1. There were 12 patients (14.5%) with high qSOFA scores. There were fewer men (41.7% vs. 73.2%, P < 0.05) and a higher incidence of S. aureus infection (P < 0.01) in the high qSOFA group. Importantly, left ventricular ejection fraction was preserved and the size of vegetation was relatively large. Of note, four patients (33.3%) with a high qSOFA score were not diagnosed with sepsis at initial hospitalization. Of those, two patients had no adverse events, two patients had cerebral infarction, and one patient died during hospitalization.
Table 1.
Baseline characteristics in high and low quick Sepsis‐related Organ Failure Assessment (qSOFA) groups of hospitalized patients with infective endocarditis
| High qSOFA (n = 12) | Low qSOFA (n = 71) | P‐value | |
|---|---|---|---|
| Age, years; median (IQR) | 69.5 (57.8–78) | 64 (52.5–73) | 0.330 |
| Male, n (%) | 5 (41.7) | 52 (73.2) | 0.043 |
| Hypertension, n (%) | 7 (58.3) | 26 (36.6) | 0.210 |
| Diabetes mellitus, n (%) | 2 (16.7) | 11 (15.5) | 1.000 |
| Dyslipidemia, n (%) | 3 (25.0) | 13 (18.3) | 0.690 |
| Chronic kidney disease, n (%) | 4 (33.3) | 11 (15.5) | 0.220 |
| Previous coronary artery disease, n (%) | 1 (8.3) | 5 (7.0) | 1.000 |
| Liver cirrhosis, n (%) | 2 (16.7) | 1 (1.4) | 0.053 |
| Atrial fibrillation, n (%) | 3 (25.0) | 12 (16.9) | 0.450 |
| Immunosuppressive agent, n (%) | 1 (8.3) | 9 (12.7) | 1.000 |
| Chronic heart failure, n (%) | 3 (25.0) | 8 (11.3) | 0.190 |
| Dental infection, n (%) | 4 (33.3) | 24 (33.8) | 1.000 |
| Causative microorganisms | |||
| Staphylococcus aureus, n (%) | 6 (50.0) | 10 (14.1) | 9.5 × 10−3 |
| MRSA, n (%) | 2 (16.7) | 4 (5.6) | 0.210 |
| Viridans streptococci, n (%) | 2 (16.7) | 19 (26.8) | 0.720 |
| Fungi, n (%) | 0 (0) | 1 (1.4) | 1.000 |
| Enterococcus spp., n (%) | 1 (8.3) | 4 (5.6) | 0.210 |
| Negative blood culture, n (%) | 2 (16.7) | 14 (19.7) | 1.000 |
| Echocardiographic findings | |||
| LVEF %, mean ± SD | 61.6 ± 11.2 | 62.4 ± 10.9 | 0.820 |
| Size of vegetation mm, median (IQR) | 10 (5.75–14) | 11 (8–17) | 0.590 |
| Vegetation profile | |||
| Native valve | |||
| Aortic valve, n (%) | 6 (50.0) | 21 (33.8) | 0.190 |
| Mitral valve, n (%) | 4 (33.3) | 35 (49.3) | 0.360 |
| Tricuspid valve, n (%) | 0 (0) | 4 (5.6) | 1.000 |
| Pulmonary valve, n (%) | 0 (0) | 2 (2.8) | 1.000 |
| Prosthetic valve, n (%) | 2 (16.7) | 6 (8.5) | 0.330 |
| Previous complication | |||
| Heart failure, n (%) | 3 (25.0) | 18 (25.4) | 1.000 |
| Cerebral infarction, n (%) | 3 (25.0) | 16 (31.4) | 1.000 |
| Peripheral embolism, n (%) | 0 (0) | 4 (5.6) | 1.000 |
| Splenic infarction, n (%) | 2 (16.7) | 6 (8.5) | 1.000 |
| Renal infarction, n (%) | 3 (25.0) | 5 (7.0) | 0.086 |
| Pulmonary embolism, n (%) | 0 (0) | 3 (4.2) | 1.000 |
| Cerebral abscess, n (%) | 0 (0) | 1 (1.4) | 1.000 |
| Spleen‐liver abscess, n (%) | 0 (0) | 1 (1.4) | 1.000 |
| Lung abscess, n (%) | 0 (0) | 1 (1.4) | 1.000 |
| Intracranial hemorrhage, n (%) | 1 (8.3) | 6 (8.5) | 1.000 |
IQR, interquartile range; LVEF, left ventricular ejection fraction; MRSA, methicillin‐resistant Staphylococcus aureus; SD, standard deviation.
Adverse events in high and low qSOFA groups
We then compared the differences of adverse events between high and low qSOFA groups (Table 1 ). On admission, the numbers of patients with embolism, abscess formation, and intracranial hemorrhage were 22, 2, and 7, respectively. The overall rate of in‐hospital adverse events in the high qSOFA group was greater than that in the low qSOFA group (83.3% vs. 38.0%, P = 4.6 × 10−3) and as follows for individual events: embolism (66.7% vs. 32.4%, P = 0.049), cerebral infarction (66.7% vs. 25.4%, P = 7.4 × 10−3), intracranial hemorrhage (33.3% vs. 7.0%, P = 0.022), and in‐hospital death (50.0% vs. 4.2%, P = 1.7 × 10−4) (Table 2).
Table 2.
List of in‐hospital adverse events among hospitalized patients with infective endocarditis
| High qSOFA n = 12 | Low qSOFA n = 71 | Total events | |
|---|---|---|---|
| At least one in‐hospital adverse event | 10 (83.3) | 27 (38.0) | 37 (44.6) |
| Death | 6 (50.0) | 3 (4.2) | 9 (10.8) |
| Embolic complications | 8 (66.7) | 23 (32.4) | 31 (36.9) |
| Cerebral infarction | 8 (66.7) | 18 (25.4) | 26 (31.3) |
| Peripheral embolism | 1 (8.3) | 3 (4.2) | 4 (4.8) |
| Pulmonary embolism | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Renal infarction | 1 (8.3) | 3 (4.2) | 4 (4.8) |
| Splenic infarction | 1 (8.3) | 2 (2.8) | 3 (3.6) |
| Hepatic infarction | 0 (0.0) | 1 (1.4) | 1 (1.2) |
| Abscess formations | 0 (0.0) | 2 (2.8) | 2 (2.4) |
| Cerebral abscess | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Spleen‐liver abscess | 0 (0.0) | 2 (2.8) | 2 (2.4) |
| Renal abscess | 0 (0.0) | 1 (1.4) | 1 (1.2) |
| Lung abscess | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Intracranial hemorrhage | 4 (33.3) | 5 (70.4) | 9 (10.8) |
Data presented as n (%).
qSOFA, quick Sepsis‐related Organ Failure Assessment.
Predictor of in‐hospital adverse events in IE patients
During hospitalization, nine patients died (10.8%) and 37 experienced at least one adverse event (44.6%) (Table 2). The causes of death were uncontrolled infection (n = 5), cerebral bleeding (n = 2), cerebral infarction (n = 1), and heart failure (n = 1). High qSOFA score and S. aureus infection were associated with in‐hospital adverse events by univariate analysis (Table 3). In the Cox proportional hazard model, presence of high qSOFA score was significantly associated with higher rate of in‐hospital adverse events (adjusted hazard ratio, 2.29; confidence interval, 1.02–5.12; P = 0.044) (Table 3). In the Kaplan–Meier curve, there was a significant difference between the high and low qSOFA groups in terms of in‐hospital adverse events (log–rank, P = 3.7 × 10−3) (Fig. 1). Regarding the diagnostic accuracy of a high qSOFA score, the sensitivity was 27.0% and the specificity was 95.7% for in‐hospital adverse events.
Table 3.
Univariate and multivariate analyses of in‐hospital adverse events among hospitalized patients with infective endocarditis
| Univariate | Multivariate | |||||
|---|---|---|---|---|---|---|
| HR | 95% CI | P‐value | HR | 95% CI | P‐value | |
| Age | 1.005 | 0.99–1.03 | 0.580 | 1.002 | 0.98–1.02 | 0.860 |
| Male sex | 0.610 | 0.31–1.21 | 0.160 | 0.900 | 0.43–1.90 | 0.780 |
| Hypertension | 1.140 | 0.59–2.19 | 0.700 | – | – | – |
| Diabetes mellitus | 0.840 | 0.33–2.17 | 0.720 | – | – | – |
| Dyslipidemia | 1.360 | 0.62–3.00 | 0.440 | – | – | – |
| CKD | 0.950 | 0.39–2.29 | 0.910 | – | – | – |
| Liver cirrhosis | 1.080 | 0.25–4.57 | 0.920 | – | – | – |
| Atrial fibrillation | 0.950 | 0.41–2.18 | 0.900 | – | – | – |
| Immunosuppressive agent | 1.070 | 0.41–2.80 | 0.890 | – | – | – |
| Chronic heart failure | 0.830 | 0.29–2.34 | 0.720 | – | – | – |
| Dental infection | 1.060 | 0.53–2.13 | 0.870 | – | – | – |
| Staphylococcus aureus | 2.390 | 1.19–4.81 | 0.015 | 1.990 | 0.95–4.16 | 0.069 |
| Viridans streptococci | 1.610 | 0.80–3.21 | 0.180 | – | – | – |
| Enterococcus spp. | 0.410 | 0.06–2.99 | 0.380 | – | – | – |
| Negative blood culture | 1.440 | 0.68–3.06 | 0.350 | – | – | – |
| LVEF | 1.010 | 0.98–1.05 | 0.360 | – | – | – |
| Size of vegetation | 1.020 | 0.98–1.08 | 0.340 | – | – | – |
| Prosthetic valve infection | 1.150 | 0.40–3.26 | 0.800 | – | – | – |
| High qSOFA score | 2.790 | 1.34–10.33 | 6.3 × 10−3 | 2.290 | 1.02–5.12 | 0.044 |
–, not applicable; CI, confidence interval; CKD, chronic kidney disease; HR, hazard ratio; LVEF, left ventricular ejection fraction; qSOFA, quick Sepsis‐related Organ Failure Assessment.
Figure 1.
Kaplan–Meier estimates of in‐hospital adverse event‐free survival in hospitalized patients with infective endocarditis by high and low quick Sepsis‐related Organ Failure Assessment (qSOFA) groups. The high qSOFA group had a lower event‐free survival rate compared to the low qSOFA group.
For each in‐hospital event, the high qSOFA group had lower rates of overall survival, embolism‐free survival, cerebral infarction‐free survival, and intracranial hemorrhage‐free survival compared to the low qSOFA group (Fig. S1). The occurrence rate of embolic events was the highest among these events. In the Cox proportional hazard model, the presence of a high qSOFA score was linked to embolic events in IE patients (adjusted hazard ratio, 2.44; confidence interval, 1.00–5.95; P = 0.049).
Discussion
In this study, we tested the hypothesis that a high qSOFA score could predict in‐hospital adverse events in IE patients. Univariate analysis showed that S. aureus infection and qSOFA score were associated with in‐hospital adverse events, and qSOFA score was the only predictor of such events in multivariate analysis. These results indicated that IE patients with high qSOFA scores had a higher incidence of in‐hospital adverse events compared to those with low qSOFA scores. However, a high qSOFA score still had lower sensitivity for predicting in‐hospital adverse events. This result could suggest that it might be important to find a better scoring system to identify poor outcomes in IE patients. Indeed, Maitra et al.24 reported similar results in the meta‐analysis of predicting in‐hospital mortality by qSOFA score in patients with suspected infection.
In the present study, high qSOFA score was an independent predictor of in‐hospital adverse events in patients with IE. The revised definition of sepsis (Sepsis‐3 definition)23 already suggested that the qSOFA score identified patients with suspected infection who were likely to have poor outcomes. Actually, in comparison to patients with qSOFA scores <2, patients with scores ≥2 showed a 3‐ to 14‐fold increase of in‐hospital mortality due to sepsis.19 Also, the presence of a high qSOFA score predicted in‐hospital mortality in a number of suspected infections more accurately than the systemic inflammatory response syndrome or SOFA score in non‐ICU patients.19, 20, 21 As for single disease, in patients with pneumonia, qSOFA score identified those at high risk of mortality and requirement of ICU admission.25 Therefore, a high qSOFA score could also be useful for IE patients, in addition to those uses reported above.
Our study had several limitations. First, we could have underestimated complications because imaging tests were undertaken at the discretion of the attending physician. However, the appropriate period for follow‐up imaging tests is not clearly established in IE patients. Second, we did not compare conventional risk scores, such as SOFA and qSOFA scores, in terms of adverse event prediction in patients with IE, because we focused on the rapid evaluation method for IE patients in primary medical settings in this study. Finally, the primary outcome included not only in‐hospital mortality but also thromboembolic events, because the number of IE patients enrolled in the study was relatively small. A further large‐scale prospective study is required to strengthen the validity of the present results.
Conclusions
High qSOFA score was significantly associated with in‐hospital adverse events in patients with IE. The qSOFA score might have the potential to be a useful tool for risk stratification in IE patients during hospitalization.
Disclosure
Approval of the research protocol: The study protocol was approved by the Institutional Review Board of Kanazawa University Hospital (approval no. 2594‐1).
Informed consent: N/A.
Registry and registration no. of the study/trial: N/A.
Animal studies: N/A.
Conflict of interest: None.
Supporting information
Figure S1 Kaplan–Meier estimates of event‐free survival in hospitalized patients with infective endocarditis by high and low quick Sepsis‐related Organ Failure Assessment (qSOFA) groups: overall survival (a), embolism‐free survival (b), cerebral infarction‐free survival (c), and intracranial hemorrhage‐free survival (d).
Acknowledgements
We would like to express our gratitude to all participants and staff involved in this study.
Funding information
No funding information provided.
References
- 1. Wallace SM, Walton BI, Kharbanda RK, Hardy R, Wilson AP, Swanton RH. Mortality from infective endocarditis: clinical predictors of outcome. Heart 2002; 88: 53–60. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Mansur AJ, Grinberg M, da Luz OL, Bellotti G. The complications of infective endocarditis. A reappraisal in the 1980s. Arch. Intern. Med. 1992; 152: 2428–32. [PubMed] [Google Scholar]
- 3. Murdoch DR, Corey GR, Hoen B et al Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis‐Prospective Cohort Study. Arch. Intern. Med. 2009; 169: 463–73. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Nomura A, Omata F, Furukawa K. Risk factors of mid‐term mortality of patients with infective endocarditis. Eur. J. Clin. Microbiol. Infect. Dis. 2010; 29: 1355–60. [DOI] [PubMed] [Google Scholar]
- 5. Hasbun R, Vikram HR, Barakat LA, Buenconsejo J, Quagliarello VJ. Complicated left‐sided native valve endocarditis in adults: risk classification for mortality. JAMA 2003; 289: 1933–40. [DOI] [PubMed] [Google Scholar]
- 6. De Castro S, Magni G, Beni S et al Role of transthoracic and transesophageal echocardiography in predicting embolic events in patients with active infective endocarditis involving native cardiac valves. Am. J. Cardiol. 1997; 80: 1030–4. [DOI] [PubMed] [Google Scholar]
- 7. Salem DN, Daudelin HD, Levine HJ, Pauker SG, Eckman MH, Riff J. Antithrombotic therapy in valvular heart disease. Chest 2001; 119(suppl): 207S–19S. [DOI] [PubMed] [Google Scholar]
- 8. Hill EE, Herijgers P, Claus P, Vanderschueren S, Herregods MC, Peetermans WE. Infective endocarditis: changing epidemiology and predictors of 6‐month mortality: a prospective cohort study. Eur. Heart J. 2007; 28: 196–203. [DOI] [PubMed] [Google Scholar]
- 9. Chu VH, Cabell CH, Benjamin DK Jr et al Early predictors of in‐hospital death in infective endocarditis. Circulation 2004; 109: 1745–9. [DOI] [PubMed] [Google Scholar]
- 10. Wang A, Athan E, Pappas PA et al Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA 2007; 297: 1354–61. [DOI] [PubMed] [Google Scholar]
- 11. Thuny F, Di Salvo G, Belliard O et al Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation 2005; 112: 69–75. [DOI] [PubMed] [Google Scholar]
- 12. Durante Mangoni E, Adinolfi LE, Tripodi MF et al Risk factors for “major” embolic events in hospitalized patients with infective endocarditis. Am. Heart J. 2003; 146: 311–6. [DOI] [PubMed] [Google Scholar]
- 13. Fowler VG Jr, Miro JM, Hoen B et al Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA 2005; 293: 3012–21. [DOI] [PubMed] [Google Scholar]
- 14. Mugge A, Daniel WG, Gunter F, Lichtlen PR. Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach. J. Am. Coll. Cardiol. 1989; 14: 631–8. [DOI] [PubMed] [Google Scholar]
- 15. Habib G, Lancellotti P, Antunes MJ et al The 2015 ESC guidelines for the management of infective endocarditis. Eur. Heart J. 2015; 36: 3075–128. [DOI] [PubMed] [Google Scholar]
- 16. Mostaghim AS, Lo HYA, Khardori N. A retrospective epidemiologic study to define risk factors, microbiology, and clinical outcomes of infective endocarditis in a large tertiary‐care teaching hospital. SAGE Open Med. 2017; 5: 1–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Vincent JL, De Mendonca A, Cantraine F et al Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis‐related problems” of the European Society of Intensive Care Medicine. Crit. Care Med. 1998; 26: 1793–800. [DOI] [PubMed] [Google Scholar]
- 18. Raith EP, Udy AA, Bailey M et al Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in‐hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA 2017; 317: 290–300. [DOI] [PubMed] [Google Scholar]
- 19. Seymour CW, Liu VX, Iwashyna TJ et al Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (sepsis‐3). JAMA 2016; 315: 762–74. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Gonzalez Del Castillo J, Julian‐Jimenez A, Gonzalez‐Martinez F et al Prognostic accuracy of SIRS criteria, qSOFA score and GYM score for 30‐day‐mortality in older non‐severely dependent infected patients attended in the emergency department. Eur. J. Clin. Microbiol. Infect. Dis. 2017; 36: 2361–9. [DOI] [PubMed] [Google Scholar]
- 21. Freund Y, Lemachatti N, Krastinova E et al Prognostic accuracy of sepsis‐3 criteria for in‐hospital mortality among patients with suspected infection presenting to the emergency department. JAMA 2017; 317: 301–8. [DOI] [PubMed] [Google Scholar]
- 22. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings: Duke Endocarditis Service. Am. J. Med. 1994; 96: 200–9. [DOI] [PubMed] [Google Scholar]
- 23. Singer M, Deutschman CS, Seymour CW et al The third international consensus definitions for sepsis and septic shock (sepsis‐3). JAMA 2016; 315: 801–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24. Maitra S, Som A, Bhattacharjee S. Accuracy of quick Sequential Organ Failure Assessment (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria for predicting mortality in hospitalized patients with suspected infection: a meta‐analysis of observational studies. Clin. Microbiol. Infect. 2018; 24: 1123–9. [DOI] [PubMed] [Google Scholar]
- 25. Chen YX, Wang JY, Guo SB. Use of CRB‐65 and quick sepsis‐related organ failure assessment to predict site of care and mortality in pneumonia patients in the emergency department: a retrospective study. Crit. Care 2016; 20: 167. [DOI] [PMC free article] [PubMed] [Google Scholar]
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Supplementary Materials
Figure S1 Kaplan–Meier estimates of event‐free survival in hospitalized patients with infective endocarditis by high and low quick Sepsis‐related Organ Failure Assessment (qSOFA) groups: overall survival (a), embolism‐free survival (b), cerebral infarction‐free survival (c), and intracranial hemorrhage‐free survival (d).