Infectious Disease · Cardiology
VIRSTA Score calculator
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Clinical inputs
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0
Low endocarditis risk (score 2 or less)
Band: Low endocarditis risk (score 2 or less)
Interpretation. Low endocarditis risk (score 2 or less)
Suggested management. In the derivation cohort, 1.1% of patients with a score of 2 or less had endocarditis (negative predictive value 98.8%). The score does not exclude endocarditis.
VIRSTA Score: 0 — Low endocarditis risk (score 2 or less). Interpretation: Low endocarditis risk (score 2 or less) What to do: In the derivation cohort, 1.1% of patients with a score of 2 or less had endocarditis (negative predictive value 98.8%). The score does not exclude endocarditis. Inputs: Cerebral or peripheral emboli (5 points): false; Meningitis (5 points): false; Permanent intracardiac device or previous infective endocarditis (4 points): false; Intravenous drug use (4 points): false; Pre-existing native valve disease (3 points): false; Persistent bacteremia (3 points): false; Vertebral osteomyelitis (2 points): false; Community or non-nosocomial healthcare-associated acquisition (2 points): false; Severe sepsis or septic shock (1 point): false; C-reactive protein above 190 mg/L (1 point): false Source: Tubiana S, Duval X, Alla F, Selton-Suty C, Tattevin P, Delahaye F, Piroth L, Chirouze C, Lavigne JP, Erpelding ML, Hoen B, Vandenesch F, Iung B, Le Moing V; VIRSTA/AEPEI Study Group. The VIRSTA score, a prediction score to estimate risk of infective endocarditis and determine priority for echocardiography in patients with Staphylococcus aureus bacteremia. J Infect. 2016;72(5):544-553. DOI: 10.1016/j.jinf.2016.02.003. The abstract names the ten predictors, assessed within 48 hours of the bacteremia diagnosis, and the cutoff. Per-item points as printed in Heriot GS, Tong SYC, Cheng AC, Liew D. JAMA Netw Open. 2020;3(4):e202401 (Table 3; DOI 10.1001/jamanetworkopen.2020.2401) and in the derivation authors' presentation of the same cohort (JNI 2015): cerebral or peripheral emboli 5, meningitis 5, permanent intracardiac device or previous infective endocarditis 4, intravenous drug use 4, pre-existing native valve disease 3, persistent bacteremia 3, vertebral osteomyelitis 2, community or non-nosocomial healthcare-associated acquisition 2, severe sepsis or shock 1, C-reactive protein above 190 mg/L 1. A score of 2 or less (39.4% of 2008 patients) carried an endocarditis risk of 1.1% with a negative predictive value of 98.8%. A score of 3 or more carried a risk of 17.4%, and the authors state that echocardiography should be performed urgently in that group. (2016)
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Clinical inputs
- Cerebral or peripheral emboli (5 points)
- Meningitis (5 points)
- Permanent intracardiac device or previous infective endocarditis (4 points)
- Intravenous drug use (4 points)
- Pre-existing native valve disease (3 points)
- Persistent bacteremia (3 points)
- Vertebral osteomyelitis (2 points)
- Community or non-nosocomial healthcare-associated acquisition (2 points)
- Severe sepsis or septic shock (1 point)
- C-reactive protein above 190 mg/L (1 point)
Primary source
Tubiana S, Duval X, Alla F, Selton-Suty C, Tattevin P, Delahaye F, Piroth L, Chirouze C, Lavigne JP, Erpelding ML, Hoen B, Vandenesch F, Iung B, Le Moing V; VIRSTA/AEPEI Study Group. The VIRSTA score, a prediction score to estimate risk of infective endocarditis and determine priority for echocardiography in patients with Staphylococcus aureus bacteremia. J Infect. 2016;72(5):544-553. DOI: 10.1016/j.jinf.2016.02.003. The abstract names the ten predictors, assessed within 48 hours of the bacteremia diagnosis, and the cutoff. Per-item points as printed in Heriot GS, Tong SYC, Cheng AC, Liew D. JAMA Netw Open. 2020;3(4):e202401 (Table 3; DOI 10.1001/jamanetworkopen.2020.2401) and in the derivation authors' presentation of the same cohort (JNI 2015): cerebral or peripheral emboli 5, meningitis 5, permanent intracardiac device or previous infective endocarditis 4, intravenous drug use 4, pre-existing native valve disease 3, persistent bacteremia 3, vertebral osteomyelitis 2, community or non-nosocomial healthcare-associated acquisition 2, severe sepsis or shock 1, C-reactive protein above 190 mg/L 1. A score of 2 or less (39.4% of 2008 patients) carried an endocarditis risk of 1.1% with a negative predictive value of 98.8%. A score of 3 or more carried a risk of 17.4%, and the authors state that echocardiography should be performed urgently in that group. (2016)
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