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.
Résumé.L'injection de B.C.G. à la Souris entraîne une augmentation de la résistance non spécifi que de l'organisme vis-à-vis de Schistosoma mansoni, se traduisant par une importante dimi nution du nombre des schistosomules pulmonaires ; les mécanismes de défense mis en jeu semblent intervenir de façon précoce dès les premiers stades de migration larvaire du para site. L'état de résistance non spécifique ainsi obtenu apparaît de façon progressive après l'ino culation du bacille ; il se maintient plusieurs semaines bien qu'il ait alors tendance à s'atté nuer. Une réinoculation de B.C.G. à l'animal déjà sensibilisé aux antigènes du bacille entraîne une immunostimulation beaucoup plus intense et dont le délai d'apparition est beaucoup plus court.
S u m m a ry .
Effects o f Bacillus Calmette and Guérin (B.C.G.) on larvae migration o f Schistosom a mansoni in mice.The injection of B.C.G. into mice results in an increase of non-specific resistance in the organism against Schistosoma mansoni characterized by a sharp reduction in the number of pulmonary schistosomules ; the defense mechanisms involved appear to act early in first stages of migration by the parasite larvae. The state of non-specific resistance thus obtained appears progressively following innoculation of the bacillus ; it is maintained for several weeks despite its tendency to weaken afterwards. Re-inoculation of B.C.G. in an animal which has already been sensitized to the antigens of the bacillus results in a immunostimulation which is far more intense and which appears much earlier on.Accepté le 14 novembre 1979.
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