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

Júnior, Fernando Pivatto; Bellagamba, Clarissa Carmona de Azevedo; Pianca, Eduardo Gatti; Fernandes, Fernando Schmidt; Butzke, Maurício; Busato, Stefano Boemler; Gus, Miguel

doi:10.36660/abc.20190050

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…EuroSCORE II was reviewed in 10 studies, STS-IE and PALSUSE score were reviewed in nine studies each. STS-IE had an overall fair discrimination performance across studies, with only 3/9 studies with an AUC < 0.7 (11,21,25). The PALSUSE score was frequently included in comparative studies but performed overall poorly with an AUC < 0.7 in five of these comparative studies (3,11,12,21,22).…”

Section: Resultsmentioning

confidence: 97%

“…There were a total of 20 relevant scores, with 14/20 being derived from and created specifically for IE populations: Table 1 ( 3 , 9 – 20 ). Non-specific scores are tabulated in Table 2 ( 3 , 9 – 12 , 14 , 21 – 27 ) and include EuroSCORE I and II, Society of Thoracic Surgery (STS) risk score, Ontario province risk (OPR) score, Charlson Co-Morbidity Index and Sequential Organ Failure Assessment (SOFA) scores. STS for IE score was considered with non-specific scores since although IE patients were considered, no IE specific characteristics (such as intra-cardiac abscess) were evaluated.…”

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%

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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: 97%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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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“…It is currently unknown which score may serve best to predict mortality. 71–73 Many of these scores are generated on small numbers of patients from a single institution or region and are unlikely to perform well when moved into another treatment venue. Hence, it seems conceivable that local validation of infective endocarditis–specific scores can help to further improve the performance of scores.…”

Section: Prediction Of Outcomementioning

confidence: 99%

Anesthesia Considerations in Infective Endocarditis

et al. 2022

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The management of infective endocarditis is complex and inherently requires multidisciplinary cooperation. About half of all patients diagnosed with infective endocarditis will meet the criteria to undergo cardiac surgery, which regularly takes place in urgent or emergency settings. The pathophysiology and clinical presentation of infective endocarditis make it a unique disorder within cardiac surgery that warrants a thorough understanding of specific characteristics in the perioperative period. This includes, among others, echocardiography, coagulation, bleeding management, or treatment of organ dysfunction. In this narrative review article, the authors summarize the current knowledge on infective endocarditis relevant for the clinical anesthesiologist in perioperative management of respective patients. Furthermore, the authors advocate for the anesthesiologist to become a structural member of the endocarditis team.

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Prognostic models for mortality after cardiac surgery in patients with infective endocarditis: a systematic review and aggregation of prediction models

Barca

García‐Esquinas

Correa-Pérez

et al. 2021

Clinical Microbiology and Infection

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Background: There are several prognostic models to estimate the risk of mortality after surgery for active infective endocarditis (IE). However, these models incorporate different predictors and their performance is uncertain. Objective: We systematically reviewed and critically appraised all available prediction models of postoperative mortality in patients undergoing surgery for IE, and aggregated them into a meta-model. Data sources: We searched Medline and EMBASE databases from inception to June 2020. Study eligibility criteria: We included studies that developed or updated a prognostic model of postoperative mortality in patient with IE. Methods: We assessed the risk of bias of the models using PROBAST (Prediction model Risk Of Bias ASsessment Tool) and we aggregated them into an aggregate meta-model based on stacked regressions and optimized it for a nationwide registry of IE patients. The meta-model performance was assessed using bootstrap validation methods and adjusted for optimism. Results: We identified 11 prognostic models for postoperative mortality. Eight models had a high risk of bias. The meta-model included weighted predictors from the remaining three models (EndoSCORE, specific ES-I and specific ES-II), which were not rated as high risk of bias and provided full model equations. Additionally, two variables (age and infectious agent) that had been modelled differently across studies, were estimated based on the nationwide registry. The performance of the meta-model

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

Cited by 7 publications

References 20 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

Anesthesia Considerations in Infective Endocarditis

Prognostic models for mortality after cardiac surgery in patients with infective endocarditis: a systematic review and aggregation of prediction models

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