RT Journal Article
SR Electronic
T1 Risk score for cardiac surgery in active left-sided infective endocarditis
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1435
OP 1442
DO 10.1136/heartjnl-2016-311093
VO 103
IS 18
A1 Olmos, Carmen
A1 Vilacosta, Isidre
A1 Habib, Gilbert
A1 Maroto, Luis
A1 Fernández, Cristina
A1 López, Javier
A1 Sarriá, Cristina
A1 Salaun, Erwan
A1 Di Stefano, Salvatore
A1 Carnero, Manuel
A1 Hubert, Sandrine
A1 Ferrera, Carlos
A1 Tirado, Gabriela
A1 Freitas-Ferraz, Afonso
A1 Sáez, Carmen
A1 Cobiella, Javier
A1 Bustamante-Munguira, Juan
A1 Sánchez-Enrique, Cristina
A1 García-Granja, Pablo Elpidio
A1 Lavoute, Cecile
A1 Obadia, Benjamin
A1 Vivas, David
A1 Gutiérrez, Ángela
A1 San Román, José Alberto
YR 2017
UL http://heart.bmj.com/content/103/18/1435.abstract
AB 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.