Assessment of perioperative mortality risk in patients with infective endocarditis undergoing cardiac surgery: performance of the EuroSCORE I and II logistic models

Madeira, Sérgio; Rodrigues, R.; Tralhão, António; Santos, Mónica; Almeida, Carla; Marques, Marta; Ferreira, Jorge; Raposo, Luís; Neves, José Pedro; Mendes, Miguel

doi:10.1093/icvts/ivv304

Cited by 38 publications

(21 citation statements)

References 24 publications

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“…The EuroSCORE II performance in estimating perioperative risk of patients undergoing surgery for IE has been evaluated by other investigators. Some researchers think that it underestimates post–cardiac surgery mortality in these patients; others have demonstrated poor calibration and comparatively poor discrimination of the system for emergency cardiac surgery . Yet, others believe that the EuroSCORE II may be a useful and appropriate tool for estimating perioperative risk, even for IE patients, and that specific endocarditis features will increase model complexity without an unequivocal improvement in predictive ability .…”

Section: Discussionmentioning

confidence: 99%

“…Currently, the risk of mortality postsurgery for IE is estimated using predictive scoring systems that have been derived from patient databases where most of the patients had had cardiac operations other than those for endocarditis . Because of this inherent limitation, the utility of these aspecific predictive systems for patients with IE has been called into question . In fact, specific scores to predict in‐hospital death postsurgery in patients with IE have also been devised, but with no external validation, and their impact in clinical practice is unclear.…”

Section: Introductionmentioning

confidence: 99%

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Simple Scoring System to Predict In‐Hospital Mortality After Surgery for Infective Endocarditis

Gatti

Perrotti

Obadia

et al. 2017

JAHA

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BackgroundAspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in‐hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis.Methods and ResultsOutcomes of 361 consecutive patients (mean age, 59.1±15.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in‐hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty‐six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate <50 mL/min (OR, 3.52; P<0.0001), New York Heart Association class IV (OR, 2.11; P=0.024), systolic pulmonary artery pressure >55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in‐hospital death. A scoring system was devised to predict in‐hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734–0.822). The score performed better than 5 of 6 scoring systems for in‐hospital death after cardiac surgery that were considered.ConclusionsA simple scoring system based on risk factors for in‐hospital death was specifically created to predict mortality risk postsurgery in patients with IE.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Simple Scoring System to Predict In‐Hospital Mortality After Surgery for Infective Endocarditis

Gatti

Perrotti

Obadia

et al. 2017

JAHA

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“…Os pacientes com EI ativa já haviam sido sub-representados na coorte do EuroSCORE, 8 na qual a EI ativa estava presente em apenas 3,6% de todos os pacientes submetidos à cirurgia valvar. Madeira et al, 23 24 em um estudo com 181 pacientes com EI (93,2% ativa), descreveram bom poder discriminatório (ASC: 0,84) e uma mortalidade esperada (27,1%) muito semelhante àquela da observada (28,8%; razão O/E: 1,1).…”

Section: Discussionunclassified

Análise de Escores de Risco para Predição de Mortalidade em Pacientes Submetidos à Cirurgia Cardíaca por Endocardite

et al. 2020

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Resumo Fundamento: Escores de risco estão disponíveis para uso na prática clínica diária, mas saber qual deles escolher é ainda incerto. Objetivos: Avaliar o EuroSCORE logístico, o EuroSCORE II e os escores específicos para endocardite infecciosa STS-IE, PALSUSE, AEPEI, EndoSCORE e RISK-E na predição de mortalidade hospitalar de pacientes submetidos à cirurgia cardíaca por endocardite ativa em um hospital terciário de ensino do sul do Brasil. Métodos: Estudo de coorte retrospectivo incluindo todos os pacientes com idade ≥ 18 anos submetidos à cirurgia cardíaca por endocardite ativa no centro do estudo entre 2007 e 2016. Foram realizadas análises de calibração (razão de mortalidade observada/esperada, O/E) e de discriminação (área sob a curva ROC, ASC), sendo a comparação das ASC realizada pelo teste de DeLong. P < 0,05 foi considerado estatisticamente significativoResultados: Foram incluídos 107 pacientes, sendo a mortalidade hospitalar de 29,0% (IC95%: 20.4-37.6%). A melhor razão de mortalidade O/E foi obtida pelo escore PALSUSE (1,01, IC95%: 0,70-1,42), seguido pelo EuroSCORE logístico (1,3, IC95%: 0,92-1,87). O EuroSCORE logístico apresentou o maior poder discriminatório (ASC 0,77), significativamente superior ao EuroSCORE II (p = 0,03), STS-IE (p = 0,03), PALSUSE (p = 0,03), AEPEI (p = 0,03) e RISK-E (p = 0,02). Conclusões: Apesar da disponibilidade dos recentes escores específicos, o EuroSCORE logístico foi o melhor preditor de mortalidade em nossa coorte, considerando-se análise de calibração (mortalidade O/E: 1,3) e de discriminação (ASC 0,77). A validação local dos escores específicos é necessária para uma melhor avaliação do risco cirúrgico. (Arq Bras Cardiol. 2020; 114(3):518-524) Palavras-chave: Procedimentos Cirúrgicos Cardiovasculares/mortalidade; Endocardite/complicações; Mortalidade Hospitalar; Medição de Risco. AbstractBackground: Risk scores are available for use in daily clinical practice, but knowing which one to choose is still fraught with uncertainty. Objectives: To assess the logistic EuroSCORE, EuroSCORE II, and the infective endocarditis (IE)-specific scores STS-IE, PALSUSE, AEPEI, EndoSCORE and RISK-E, as predictors of hospital mortality in patients undergoing cardiac surgery for active IE at a tertiary teaching hospital in Southern Brazil. Methods: Retrospective cohort study including all patients aged ≥ 18 years who underwent cardiac surgery for active IE at the study facility from 2007-2016. The scores were assessed by calibration evaluation (observed/expected [O/E] mortality ratio) and discrimination (area under the ROC curve [AUC]). Comparison of AUC was performed by the DeLong test. A p < 0.05 was considered statistically significant.Results: A total of 107 patients were included. Overall hospital mortality was 29. . The best O/E mortality ratio was achieved by the PALSUSE score (1.01,, followed by the logistic EuroSCORE (1.3, 95%CI: 0.92-1.87). The logistic EuroSCORE had the highest discriminatory power (AUC 0.77), which was significantly superior to EuroSCORE II (p = 0.03), STS-I...

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“…Adult data has described scoring systems in an attempt to counsel families and decide on surgical candidacy based on comorbidities. [27][28][29][30] Multidisciplinary teams charged with the care of these patients have also been suggested to optimize care and appropriately risk stratify. 31…”

Section: Discussionmentioning

confidence: 99%

A Case of Mitral Valve Endocarditis Complicated by Multiple Embolic Phenomena: Leaping from Adult Guidelines to Pediatric Critical Care Decisions

Choudhury

Flyer

Ushay

et al. 2018

J Pediatr Intensive Care

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Early surgical intervention for children with infective endocarditis (IE) and cerebrovascular sequelae has significant risks, resulting in practice variation amongst pediatric cardiologists, intensivists, and cardiothoracic surgeons. The limited pediatric consensus recommendations make decision making for practitioners challenging. The added risk of multiorgan dysfunction syndrome can make these decisions even more difficult. We present the case of a 14-year-old with IE and resultant multiorgan dysfunction syndrome including cerebrovascular complication, successfully treated by primary valve repair within the 1st week of diagnosis.

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Assessment of perioperative mortality risk in patients with infective endocarditis undergoing cardiac surgery: performance of the EuroSCORE I and II logistic models

Abstract: Both EuroSCORE I and II satisfactorily stratify risk in active infective endocarditis; however, EuroSCORE II performed better in the overall comparison. Specific endocarditis features will increase model complexity without an unequivocal improvement in predictive ability.

Cited by 38 publications

References 24 publications

Simple Scoring System to Predict In‐Hospital Mortality After Surgery for Infective Endocarditis

Simple Scoring System to Predict In‐Hospital Mortality After Surgery for Infective Endocarditis

Análise de Escores de Risco para Predição de Mortalidade em Pacientes Submetidos à Cirurgia Cardíaca por Endocardite

A Case of Mitral Valve Endocarditis Complicated by Multiple Embolic Phenomena: Leaping from Adult Guidelines to Pediatric Critical Care Decisions

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