Performance of Endocarditis-Specific Risk Scores in Surgery for Infective Endocarditis
08 December 2016
10 March 2017
20 April 2017 (eFirst)
Background Risk models can play an important part in the decision-making of surgery for infective endocarditis, but they remain underutilized. Several endocarditis-specific risk models have been recently published with the aim to improve on existing general cardiac surgery scores such as EuroSCORE. We compared their prognostic utility of mortality and morbidities for infective endocarditis surgery.
Methods The additive Society of Thoracic Surgeon's (STS) Endocarditis score, Costa score, De Feo-Cotrufo score, and Pulsuse score were calculated for consecutive patients undergoing cardiac surgery for active infective endocarditis during 2005 to 2011 at Auckland City Hospital and their discriminative value for adverse outcomes assessed.
Results Mean scores for 146 endocarditis surgery patients with operative mortality 6.8% (10) were additive STS score: 32.2 ± 13.5, Costa score: 12.0 ± 6.8, De Feo-Cotrufo score: 14.6 ± 9.2, and Pulsuse score 2.2 ± 1.3. Areas under curve and 95% confidence intervals for operative mortality were 0.699 (0.534–0.865), 0.596 (0.426–0.765), 0.744 (0.590–0.899), and 0.673 (0.510–0.836), respectively. All four scores could also discriminate mortality during follow-up and composite morbidity, with the De Feo-Cotrufo score having the best overall performance.
Conclusion Endocarditis-specific risk models had moderate discrimination of operative mortality and most postoperative complications, and the De Feo-Cotrufo score is the preferred score to advise clinical decisions in this setting.
- 1 Habib G, Lancellotti P, Antunes MJ. , et al; Document Reviewers. 2015 ESC guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36 (44) 3075-3128
- 2 Gaca JG, Sheng S, Daneshmand MA. , et al. Outcomes for endocarditis surgery in North America: a simplified risk scoring system. J Thorac Cardiovasc Surg 2011; 141 (01) 98-106.e1 , 2
- 3 De Feo M, Cotrufo M, Carozza A. , et al. The need for a specific risk prediction system in native valve infective endocarditis surgery. Sci World J 2012; 2012: 307571
- 4 Costa MA, Wollmann Jr DR, Campos AC. , et al. Risk index for death by infective endocarditis: a multivariate logistic model. Rev Bras Cir Cardiovasc 2007; 22 (02) 192-200
- 5 Martínez-Sellés M, Muñoz P, Arnáiz A. , et al; Spanish Collaboration on Endocarditis—Grupo de Apoyo al Manejo de la Endocarditis infecciosa en ESpaña (GAMES). Valve surgery in active infective endocarditis: a simple score to predict in-hospital prognosis. Int J Cardiol 2014; 175 (01) 133-137
- 6 Wang TK, Oh T, Voss J, Gamble G, Kang N, Pemberton J. Comparison of contemporary risk scores for predicting outcomes after surgery for active infective endocarditis. Heart Vessels 2015; 30 (02) 227-234