Risk scores and surgery for infective endocarditis: in search of a good predictive score

Gatti, Giuseppe; Sponga, Sandro; Peghin, Maddalena; Givone, Filippo; Ferrara, Veronica; Benussi, Bernardo; Mazzaro, Enzo; Perrotti, Andréa; Luzzati, Roberto; Chocron, Sidney; Pappalardo, Aniello; Livi, Ugolino

doi:10.1080/14017431.2019.1610188

Cited by 15 publications

(16 citation statements)

References 28 publications

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“…Long-term outcome data for IE patients is often unavailable. The majority of studies considered in-hospital mortality or mortality within 30 days as the primary end-point ( 3 , 9 – 14 , 16 , 19 , 22 – 25 , 28 ), some interchangeably. Other end-points included 6-month mortality ( 17 ), urgent surgery OR in-hospital mortality ( 18 ) and long-term mortality of 29 months ( 19 ) and 5 years ( 20 ).…”

Section: Resultsmentioning

confidence: 99%

“…Nonspecific scores are tabulated in AEPEI, SHARPEN and Cystatin C scores, although made for IE populations, did not include specific variables pertaining to IE such as: micro-organism, embolic events, degree of myocardial/valve damage, abscess formation and large vegetations, although these were evaluated. Discrimination performance was classified depending on AUC: Excellent with AUC 0.9-1.0, good with AUC 0.8-0.9, fair with AUC 0.7-0.8, poor with AUC 0.6-0.7, and very poor with AUC 0.5-0.6 (28).…”

Section: Resultsmentioning

confidence: 99%

“…The scores assessed in this review and corresponding AUC results from different studies are tabulated in Tables 1, 2 (3,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Of these scores, only six have been externally validated in a separate cohort (3,12,14,17,18).…”

Section: Resultsmentioning

confidence: 99%

“…Only 6 of the 14 IE-specific scores proposed have undergone formal external validation, limiting their transportability. The absence of externally validated scores has been highlighted multiple times in the literature and analysis of the European IE-Registry (EURO-ENDO) was proposed to achieve this aim ( 28 ). Despite the lack of external validation, many scores have been frequently re-assessed in separate studies with different cohorts.…”

Section: Discussionmentioning

confidence: 99%

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Infective endocarditis: Do we have an effective risk score model? A systematic review

Rizzo

Salmasi²,

Sabetai³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundInfective endocarditis (IE) is a rare, highly morbid condition with 17% in-hospital mortality. A total of 25–30% require surgery and there is ongoing debate with regard to markers predicting patient outcomes and guiding intervention. This systematic review aims to evaluate all IE risk scores currently available.MethodsStandard methodology (PRISMA guideline) was used. Papers with risk score analysis for IE patients were included, with attention to studies reporting area under the receiver-operating characteristic curve (AUC/ROC). Qualitative analysis was carried out, including assessment of validation processes and comparison of these results to original derivation cohorts where available. Risk-of-bias analysis illustrated according to PROBAST guidelines.ResultsOf 75 articles initially identified, 32 papers were analyzed for a total of 20 proposed scores (range 66–13,000 patients), 14 of which were specific for IE. The number of variables per score ranged from 3 to 14 with only 50% including microbiological variables and 15% including biomarkers. The following scores had good performance (AUC > 0.8) in studies proposing the score (often the derivation cohort); however fared poorly when applied to a new cohort: PALSUSE, DeFeo, ANCLA, RISK-E, EndoSCORE, MELD-XI, COSTA, and SHARPEN. DeFeo score demonstrated the largest discrepancy with initial AUC of 0.88, compared to 0.58 when applied to different cohorts. The inflammatory response in IE has been well documented and CRP has been found to be an independent predictor for worse outcomes. There is ongoing investigation on alternate inflammatory biomarkers which may assist in IE management. Of the scores identified in this review, only three have included a biomarker as a predictor.ConclusionDespite the variety of available scores, their development has been limited by small sample size, retrospective collection of data and short-term outcomes, with lack of external validation, limiting their transportability. Future population studies and large comprehensive registries are required to address this unmet clinical need.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Infective endocarditis: Do we have an effective risk score model? A systematic review

Rizzo

Salmasi²,

Sabetai³

et al. 2023

Front. Cardiovasc. Med.

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“…Some have also been shown to predict in-hospital mortality even in patients treated without CS [16]. One significant drawback of these scores is their performance in external cohorts [2,[17][18][19][20]. At an individual patient level, the indication for CS in the face of extreme operative risk and marginal chances of meaningful survival is controversial.…”

Section: Introductionmentioning

confidence: 99%

Risk scores’ performance and their impact on operative decision-making in left-sided endocarditis: a cohort study

Fernández-Cisneros

Hernández‐Meneses

Llopis

et al. 2022

Eur J Clin Microbiol Infect Dis

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The accuracy of contemporary risk scores in predicting perioperative mortality in infective endocarditis (IE) remains controversial. The aim is to evaluate the performance of existent mortality risk scores for cardiovascular surgery in IE and the impact on operability at high-risk thresholds. A single-center retrospective review of adult patients diagnosed with acute left-sided IE undergoing surgery from May 2014 to August 2019 (n = 142) was done. Individualized risk calculation was obtained according to the available mortality risk scores: EuroScore I and II, PALSUSE, Risk-E, Costa, De Feo-Cotrufo, AEPEI, STS-risk, STS-IE, APORTEI, and ICE-PCS scores. A cross-validation analysis was performed on the score with the best area under the curve (AUC). The 30-day survival was 96.5% (95%CI 91–98%). The score with worse area under the curve (AUC = 0.6) was the STS-IE score, while the higher was for the RISK-E score (AUC = 0.89). The AUC of the majority of risk scores suggested acceptable performance; however, statistically significant differences in expected versus observed mortalities were common. The cross-validation analysis showed that a large number of survivors (> 75%) would not have been operated if arbitrary high-risk threshold estimates had been used to deny surgery. The observed mortality in our cohort is significantly lower than is predicted by contemporary risk scores. Despite the reasonable numeric performance of the analyzed scores, their utility in judging the operability of a given patient remains questionable, as demonstrated in the cross-validation analysis. Future guidelines may advise that denial of surgery should only follow a highly experienced Endocarditis Team evaluation.

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Perioperative risk stratification scores in infective endocarditis and its usefulness

Varela-Barca,

López-Menéndez

2023

Indian J Thorac Cardiovasc Surg

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Risk scores and surgery for infective endocarditis: in search of a good predictive score

Cited by 15 publications

References 28 publications

Infective endocarditis: Do we have an effective risk score model? A systematic review

Infective endocarditis: Do we have an effective risk score model? A systematic review

Risk scores’ performance and their impact on operative decision-making in left-sided endocarditis: a cohort study

Perioperative risk stratification scores in infective endocarditis and its usefulness

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