Enfektif endokarditli hastalarda serebral embolik olayları öngörmede CHA₂DS₂-VASc skorunun kullanımı

Year 2025, Volume: 8 Issue: 4, 556 - 563, 30.07.2025

Anar Mammadli , Ayşe İrem Demirtola , Duygu İnan

https://doi.org/10.32322/jhsm.1683602

Abstract

Amaç:
Serebral embolik olaylar (SEO), enfektif endokarditin (EE) en ciddi komplikasyonları arasında yer almakta olup, klinik pratikte risk sınıflaması hâlâ zorluk arz etmektedir. Bu çalışmanın amacı, EE’nin aktif fazında SEO’ları öngörmede kolay ve ulaşılabilir bir klinik araç olan CHA₂DS₂-VASc skorunun kullanım değerini araştırmaktır.
Yöntem:
Bu retrospektif, tek merkezli çalışmaya kesin EE tanısı alan 158 hasta dahil edildi. SEO, nörogörüntüleme ile doğrulanmış iskemik inme veya geçici iskemik atak olarak tanımlandı. CHA₂DS₂-VASc skoru ile SEO arasındaki ilişki lojistik regresyon ile değerlendirildi. İki model oluşturuldu: Model 1 (temel klinik ve ekokardiyografik değişkenler) ve Model 2 (Model 1 + CHA₂DS₂-VASc). Model performansı AUC, AIC, Nagelkerke R², Brier Skoru, kalibrasyon eğrisi ve karar eğrisi analizi ile değerlendirildi.
Bulgular:
SEO, 32 hastada (%20) gelişti. CHA₂DS₂-VASc skoru SEO gelişen hastalarda anlamlı olarak daha yüksekti (p = 0.011) ve çok değişkenli analizde bağımsız bir öngörücü olarak saptandı (OR 3.00, %95 GA: 1.26–7.18, p = 0.013). CHA₂DS₂-VASc skorunun modele dahil edilmesi, ayırt edici gücü anlamlı ölçüde artırdı (AUC: 0.686 → 0.732). Skor için belirlenen eşik değeri olan 2, SEO riski olan hastaların saptanmasında iyi bir duyarlılık ve özgüllük sağladı. Özellikle, bu skorun öngörücü gücü sol taraflı EE, protez materyal varlığı, atriyal fibrilasyon ve korunmuş ejeksiyon fraksiyonu olan alt gruplarda da korundu.
Sonuç:
CHA₂DS₂-VASc skoru, EE hastalarında SEO gelişimini öngörmede güçlü ve bağımsız bir prediktördür. Bu skoru klinik değerlendirmeye entegre etmek, özellikle hastalığın aktif fazında emboli risk sınıflamasını iyileştirebilir ve yüksek riskli bu popülasyonda zamanında karar vermeyi destekleyebilir.

Keywords

Enfektif endokardit , CHA₂DS₂-VASc , İntrakraniyal emboli , Risk değerlendirmesi

Ethical Statement

Bu çalışma, Başakşehir Çam ve Sakura Şehir Hastanesi Etik Kurulu tarafından onaylanmıştır (Onay Numarası: KAEK/2025.117). “İnfektif Endokardit Hastalarında Serebral Embolik Olayları Öngörmede CHA₂DS₂-VASc Skorunun Rolü” başlıklı araştırma dosyası, kurul tarafından değerlendirilmiş ve etik açıdan uygun bulunmuştur.

Supporting Institution

Yok

Project Number

None

Thanks

Yok

Utility of the CHA₂DS₂-VASc score for predicting cerebral embolic events in patients with infective endocarditis

Abstract

Aims: Cerebral embolic events (CEEs) are among the most serious complications of infective endocarditis (IE), yet risk stratification remains challenging in routine clinical practice. This study aimed to evaluate the utility of the CHA₂DS₂-VASc score in predicting CEEs during the active phase of IE, using a simple and accessible clinical tool.
Methods: This retrospective single-center study included 158 patients with definite IE. CEEs were defined as ischemic stroke or transient ischemic attack confirmed by neuroimaging. The association between the CHA₂DS₂-VASc score and CEEs was assessed using logistic regression. Two models were constructed; model 1 (baseline clinical and echocardiographic variables) and model 2 (model 1+CHA₂DS₂-VASc). Model performance was evaluated using AUC, AIC, Nagelkerke R², Brier Score, calibration curve, and decision curve analysis.
Results: CEEs occurred in 32 patients (20%). The CHA₂DS₂-VASc score was significantly higher in patients with CEEs (p=0.011) and remained an independent predictor in multivariate analysis (OR 3.00, 95% CI: 1.26-7.18, p=0.013). Incorporating the CHA₂DS₂-VASc score into the predictive model led to a substantial improvement in discrimination, increasing the AUC from 0.686 to 0.732. A threshold score of 2 provided optimal classification, demonstrating favorable sensitivity and specificity for identifying patients at risk of CEEs. Notably, the predictive value of the score remained robust across key subgroups, including those with left-sided IE, prosthetic material, atrial fibrillation, and preserved ejection fraction.
Conclusion: The CHA₂DS₂-VASc score is a strong and independent predictor of CEEs in patients with IE. Its integration into clinical assessment may enhance embolic risk stratification, particularly during the active phase of the disease, and support timely decision-making in this high-risk population.

Keywords

Infective endocarditis , CHA₂DS₂-VASc , intracranial embolism , risk assessment

Ethical Statement

This study was approved by the Ethics Committee of Başakşehir Çam and Sakura City Hospital (Approval Number: KAEK/2025.117). The protocol titled “The Role of the CHA₂DS₂-VASc Score in Predicting Cerebral Embolic Events in Patients with Infective Endocarditis” was reviewed and deemed ethically appropriate by the committee

Supporting Institution

None

Project Number

None

Thanks

None

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