The NOVA Score: A Proposal to Reduce the Need for Transesophageal Echocardiography in Patients With Enterococcal Bacteremia
The NOVA Score: A Proposal to Reduce the Need for Transesophageal Echocardiography in Patients With Enterococcal Bacteremia
复制标题
DOI：
10.1093/cid/ciu872
复制
发表时间：
2015-02-15
影响因子：
11.8
通讯作者：
Munoz, Patricia
中科院分区：
文献类型：
--
作者：
Bouza, Emilio;Kestler, Martha;Munoz, Patricia
背景肠球菌血流感染（E-BSI）的频率正在增加，并发感染性心内膜炎（IE）的发作次数各不相同。在所有E-BSI患者中进行经食管超声心动图（TEE）是昂贵且耗时的。我们的目的是确定E-BSI患者谁是肠球菌性IE的风险非常低（因此不需要TEE），并比较E-BSI的结果与/不IE的患者。2003年9月至2012年10月，我们在本中心进行了一项前瞻性队列研究（所有E-BSI患者）和一项病例对照研究（有/无肠球菌IE患者）。我们检测了1515例E-BSI患者和65例肠球菌性IE患者（占所有E-BSI发作的4.29%，16.7%的E-BSI患者接受了经胸超声心动图检查，35.5%的E-BSI患者接受了TEE检查）。我们开发了一种肠球菌IE的床旁预测评分-阳性血培养数量、菌血症起源、既往瓣膜疾病、心脏杂音听诊（NOVA）评分-基于以下变量：（3/3例血培养或大多数血培养，如果超过3例），5分;菌血症来源不明，4分;既往心脏瓣膜疾病，2分;心脏杂音听诊，1分（受试者工作特性= 0.83）。最佳截止值对应于评分>= 4（灵敏度，100%;特异性，29%）。的分数
Background. Frequency of enterococcal bloodstream infection (E-BSI) is increasing, and the number of episodes complicated by infective endocarditis (IE) varies. Performing transesophageal echocardiography (TEE) in all patients with E-BSI is costly and time-consuming. Our objectives were to identify patients with E-BSI who are at very low risk of enterococcal IE (and therefore do not require TEE) and to compare the outcome of E-BSI in patients with/without IE.Methods. Between September 2003 and October 2012, we performed a prospective cohort study (all patients with E-BSI) and a case-control study (patients with/without enterococcal IE) in our center.Results. We detected 1515 patients with E-BSI and 65 with enterococcal IE (4.29% of all episodes of E-BSI, 16.7% of patients with E-BSI who underwent transthoracic echocardiography, and 35.5% of all patients with E-BSI who underwent TEE). We developed a bedside predictive score for enterococcal IE-Number of positive blood cultures, Origin of the bacteremia, previous Valve disease, Auscultation of heart murmur (NOVA) score-based on the following variables: Number of positive blood cultures (3/3 blood cultures or the majority if more than 3), 5 points; unknown Origin of bacteremia, 4 points; prior heart Valve disease, 2 points; Auscultation of a heart murmur, 1 point (receiver operating characteristic = 0.83). The best cutoff corresponded to a score >= 4 (sensitivity, 100%; specificity, 29%). A score