Clinical utility of the DENOVA score for predicting infective endocarditis in Enterococcus faecalis bacteraemia: external validation with decision curve analysis.
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Varisco Benedetta, Piovani Daniele, Del Turco Elena Rosselli, Bussini Linda, Paul Mical, Sabik Eman Fares, Castagna Antonella, Ripa Marco, Gomes Marisa Z R, Di Bella Stefano, Zerbato Verena, Lopez Alicia Beteta, Franceschini Erica, Bandera Alessandra, Oliva Alessandra, Gavaruzzi Francesca, Muñoz Patricia, Mularoni Alessandra, Seminari Elena, Morelli Paola, Pocaterra Daria, Tascini Carlo, Papadimitriou-Olivgeris Matthaios, Coppola Nicola, Cristini Francesco, Russo Alessandro, Bassetti Matteo, Travi Giovanna, Lopez-Contreras Joaquin, Viale Pierluigi, Cento Valeria, Diella Lucia, Bavaro Davide Fiore, Gaibani Paolo, Giannella Maddalena, Bartoletti Michele, ESCMID Study Group of Bloodstream Infection, Endocarditis and Sepsis (ESGBIES) and the EfFAECT study group
Аннотация
METHODS: Prospective multicentre cohort study (2019-2024) conducted across 23 centres in six countries (Italy, Spain, Israel, Brazil, Switzerland, and Romania), including adult patients with monomicrobial EfB who underwent at least one echocardiographic evaluation as part of the study protocol. Definite IE was defined according to the 2023 Duke criteria. The DENOVA score was externally validated; discrimination was assessed by the area under the receiver operating characteristic curve, calibration by observed versus predicted risk plots, and clinical utility by decision curve analysis at the predefined threshold (DENOVA ≥3). Performance of the NOVA score was evaluated as a secondary analysis.
RESULTS: Among 543 patients, 125 (23.0%) were diagnosed with IE. When evaluated as a continuous variable, the DENOVA score showed an area under the receiver operating characteristic curve of 0.871 (95% CI 0.835-0.906). At the predefined threshold (DENOVA ≥3), sensitivity was 79.2% (95% CI 71.0-85.9) and specificity was 83.0% (95% CI 79.1-86.5). Decision curve analysis showed that DENOVA ≥3 was associated with positive net clinical benefit across most threshold probabilities, with a reduction in unnecessary transoesophageal echocardiographies.
CONCLUSIONS: The study demonstrated that DENOVA supports risk stratification for IE in patients with EfB, informing clinical decision-making and use of transoesophageal echocardiography.