Risk scores' performance and their impact on operative decision‑making in left‑sided endocarditis: a cohort study

Theaccuracy of contemporary risk scores in predicting perioperative mortality in infective endocarditis (IE) remains controversial. The aim is to evaluate the performance of existent mortality risk scores for cardiovascular surgery in IE and the impact on operability at high-risk thresholds. A singl...

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Detalles Bibliográficos
Autores: Fernández Cisneros, A., Hernández Meneses, Marta, Llopis Pérez, Jaime, Sandoval, Elena, Pereda, Daniel, Alcocer, J., Barriuso, Clemente, Castellà Pericàs, Manuel, Ambrosioni, J., Pericàs, Juan M., Vidal, B., Falces Salvador, Carles, Ibáñez,C., Perdomo, Juan Manuel, Rovira, I., García de la Mària, Cristina, Moreno, A., Almela, M. (Manel), Perisinotti, A., Dahl, A., Castro Rebollo, Pedro, Miró Meda, José M. (José María), 1956-, Quintana, Eduard, Equip d'Endocarditis de l'Hospital Clínic de Barcelona
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/193716
Acceso en línea:https://hdl.handle.net/2445/193716
Access Level:acceso abierto
Palabra clave:Endocarditis
Cirurgia cardiovascular
Factors de risc en les malalties
Cardiovascular surgery
Risk factors in diseases
Descripción
Sumario:Theaccuracy of contemporary risk scores in predicting perioperative mortality in infective endocarditis (IE) remains controversial. The aim is to evaluate the performance of existent mortality risk scores for cardiovascular surgery in IE and the impact on operability at high-risk thresholds. A single-center retrospective review of adult patients diagnosed with acute left-sided IE undergoing surgery from May 2014 to August 2019 (n = 142) was done. Individualized risk calculation was obtained according to the available mortality risk scores: EuroScore I and II, PALSUSE, Risk-E, Costa, De Feo-Cotrufo, AEPEI, STS-risk, STS-IE, APORTEI, and ICE-PCS scores. A cross-validation analysis was performed on the score with the best area under the curve (AUC). The 30-day survival was 96.5% (95%CI 91-98%). The score with worse area under the curve (AUC = 0.6) was the STS-IE score, while the higher was for the RISK-E score (AUC = 0.89). The AUC of the majority of risk scores suggested acceptable performance; however, statistically significant differences in expected versus observed mortalities were common. The cross-validation analysis showed that a large number of survivors (> 75%) would not have been operated if arbitrary high-risk threshold estimates had been used to deny surgery. The observed mortality in our cohort is significantly lower than is predicted by contemporary risk scores. Despite the reasonable numeric performance of the analyzed scores, their utility in judging the operability of a given patient remains questionable, as demonstrated in the cross-validation analysis. Future guidelines may advise that denial of surgery should only follow a highly experienced Endocarditis Team evaluation.

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