Simple Scoring System to Predict In‐Hospital Mortality After Surgery for Infective Endocarditis

Abstract

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.

Predictors of early mortality after surgical treatment of infective endocarditis: a single-center experience

“…5 BMI > 27 kg/m 2 is a statistically significant factor associated with lethal outcomes (p = 0.039). 6,7 Among the many pathogens cultured from patients, S. aureus is particularly concerning as it may be associated with higher mortality rates, ranging from 23% to 45% in published reports. 8 S. aureus was the main pathogen among all our study patients with IE (30.8% in non-survivor group vs. 8.1% in survivor group patients).…”

A Simple Clinical Pre-procedure Risk Model for Predicting Thrombocytopenia Associated With Periprocedural Use of Tirofiban in Patients Undergoing Percutaneous Coronary Intervention

“…Furthermore, there may be indeed insufficient power to determine higher dimensional models in the scoring system. However, this is a common problem to the existing scoring systems to predict the risk of adverse drug reaction or clinical outcomes with low frequency (Gatti et al, 2017). To solve this problem, larger sample cohort should be needed in further investigation.…”

Escores Prognósticos de Mortalidade na Cirurgia Cardíaca para Endocardite Infecciosa

“…Embora não sejam específicos para endocardite, o Euroscore e o Euroscore II levam em consideração a endocardite ativa como uma variável importante associada à mortalidade operatória (ver Tabela 1). É importante ressaltar que foram criados vários escores mais específicos para a endocardite, incluindo variáveis com peso significativo em relação à gravidade dessa condição, [8][9][10][11][12][13] mostradas na tabela 1 do artigo de Pivatto Jr F et al 1 As características específicas da EI são: EI de válvula protética, grande destruição intracardíaca, Staphylococcus spp., patógeno isolado na cultura de amostras de sangue (ou seja, hemoculturas positivas), presença de abscesso, complicações perivalvares, microrganismo virulento; além destes, há bloqueio atrioventricular e microrganismos Gram-negativos não-HACEK (os últimos 2 para o modelo INC-Rio 4 ) e envolvimento perivalvar (por exemplo, abscesso anular ou fístula aortocavitária). 13 Quando agrupados, além do envolvimento da prótese, essencialmente o tipo de microrganismo e a destruição da válvula (bloqueio AV sinalizando abscesso perivalvar) são as características distintivas desses "escores de EI" (ver Tabela 2).…”