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Original research article
Risk score for cardiac surgery in active left-sided infective endocarditis
  1. Carmen Olmos1,
  2. Isidre Vilacosta1,
  3. Gilbert Habib2,3,
  4. Luis Maroto1,
  5. Cristina Fernández1,
  6. Javier López4,
  7. Cristina Sarriá5,
  8. Erwan Salaun2,3,
  9. Salvatore Di Stefano4,
  10. Manuel Carnero1,
  11. Sandrine Hubert3,
  12. Carlos Ferrera1,
  13. Gabriela Tirado1,
  14. Afonso Freitas-Ferraz1,
  15. Carmen Sáez5,
  16. Javier Cobiella1,
  17. Juan Bustamante-Munguira5,
  18. Cristina Sánchez-Enrique1,
  19. Pablo Elpidio García-Granja4,
  20. Cecile Lavoute3,
  21. Benjamin Obadia3,
  22. David Vivas1,
  23. Ángela Gutiérrez5,
  24. José Alberto San Román4
  1. 1 Instituto Cardiovascular. Hospital Universitario Clínico San Carlos, Madrid, Spain
  2. 2 Aix-Marseille Université, Marseille, France
  3. 3 Department of Cardiology, APHM, La Timone Hospital, Marseille, France
  4. 4 Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
  5. 5 Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
  1. Correspondence to Dr Carmen Olmos, Cardiovascular Institute, C/Profesor Martín Lagos, Madrid 28040, Madrid, Spain; carmen.olmosblanco{at}


Objective To develop and validate a calculator to predict the risk of in-hospital mortality in patients with active infective endocarditis (IE) undergoing cardiac surgery.

Methods Thousand two hundred and ninety-nine consecutive patients with IE were prospectively recruited (1996–2014) and retrospectively analysed. Left-sided patients who underwent cardiac surgery (n=671) form our study population and were randomised into development (n=424) and validation (n=247) samples. Variables statistically significant to predict in-mortality were integrated in a multivariable prediction model, the Risk-Endocarditis Score (RISK-E). The predictive performance of the score and four existing surgical scores (European System for Cardiac Operative Risk Evaluation (EuroSCORE) I and II), Prosthesis, Age ≥70, Large Intracardiac Destruction, Staphylococcus, Urgent Surgery, Sex (Female) (PALSUSE), EuroSCORE ≥10) and Society of Thoracic Surgeons’s Infective endocarditis score (STS-IE)) were assessed and compared in our cohort. Finally, an external validation of the RISK-E in a separate population was done.

RESULTS Variables included in the final model were age, prosthetic infection, periannular complications, Staphylococcus aureus or fungi infection, acute renal failure, septic shock, cardiogenic shock and thrombocytopaenia. Area under the receiver operating characteristic curve in the validation sample was 0.82 (95% CI 0.75 to 0.88). The accuracy of the other surgical scores when compared with the RISK-E was inferior (p=0.010). Our score also obtained a good predictive performance, area under the curve 0.76 (95% CI 0.64 to 0.88),in the external validation.

Conclusions IE-specific factors (microorganisms, periannular complications and sepsis) beside classical variables in heart surgery (age, haemodynamic condition and renal failure) independently predicted perioperative mortality in IE. The RISK-E had better ability to predict surgical mortality in patients with IE when compared with other surgical scores.

  • Cardiac surgery
  • Endocarditis

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  • Contributors CO, IV, ASR, CS, CFP and JL had the original idea and wrote the initial draft of the manuscript. CO and CFP had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. CF, ES, SH, GH, GT, AFF, CS, CSE, EGG, BO, AG, MC, LM, JC, DV, SDS and JB contributed substantially to the study design, data analysis and interpretation and the writing of the manuscript.

  • Competing interests None declared.

  • Ethics approval Hospital Clnico San Carlos ethical committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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