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Assessment of perioperative mortality risk in patients with infective endocarditis undergoing cardiac surgery: performance of the EuroSCORE I and II logistic models

2016Journal article Open access
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dc.contributor.authorMadeira, Sérgio
dc.contributor.authorRodrigues, Ricardo
dc.contributor.authorTralhão, António
dc.contributor.authorSantos, Miguel
dc.contributor.authorAlmeida, Carla
dc.contributor.authorMarques, Marta
dc.contributor.authorFerreira, Jorge
dc.contributor.authorRaposo, Luís
dc.contributor.authorNeves, José
dc.contributor.authorMendes, Miguel
dc.date.accessioned2019-08-01T16:48:13Z
dc.date.available2019-08-01T16:48:13Z
dc.date.issued2016
dc.description.abstractOBJECTIVES: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) has been established as a tool for assisting decision- making in surgical patients and as a benchmark for quality assessment. Infective endocarditis often equires surgical treatment and is associated with high mortality. This study was undertaken to (i) validate both versions of the EuroSCORE, the older logistic EuroSCORE I and the recently developed EuroSCORE II and to compare their performances; (ii) identify predictors other than those included in the EuroSCORE models that might further improve their performance. METHODS: We retrospectively studied 128 patients from a single-centre registry who underwent heart surgery for active infective endocarditis between January 2007 and November 2014. Binary logistic regression was used to find independent predictors of mortality and to create a new prediction model. Discrimination and calibration of models were assessed by receiver-operating characteristic curve analysis, calibration curves and the Hosmer–Lemeshow test. RESULTS: The observed perioperative mortality was 16.4% (n = 21). The median EuroSCORE I and EuroSCORE II were 13.9% interquartile range (IQ) (7.0–35.0) and 6.6% IQ (3.5–18.2), respectively. Discriminative power was numerically higher for EuroSCORE II {area under the curve (AUC) of 0.83 [95% confidence interval (CI), 0.75–0.91]} than for EuroSCORE I [0.75 (95% CI, 0.66–0.85), P = 0.09]. The Hosmer– Lemeshow test showed good calibration for EuroSCORE II (P = 0.08) but not for EuroSCORE I (P = 0.04). EuroSCORE I tended to overpredict and EuroSCORE II to under-predict mortality. Among the variables known to be associated with greater infective endocarditis severity, only prosthetic valve infective endocarditis remained an independent predictor of mortality [odds ratio (OR) 6.6; 95% CI, 1.1–39.5; P = 0.04]. The new model including the EuroSCORE II variables and variables known to be associated with greater infective endocarditis severity showed an AUC of 0.87 (95% CI, 0.79–0.94) and differed significantly from EuroSCORE I (P = 0.03) but not from EuroSCORE II (P = 0.4). CONCLUSIONS: Both EuroSCORE I and II satisfactorily stratify risk in active infective endocarditis; however, EuroSCORE II performed better in the overall comparison. Specific endocarditis features will increase model complexity without an unequivocal improvement in predictive ability.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationInteractive CardioVascular and Thoracic Surgery 22 (2016) 141–148pt_PT
dc.identifier.doi10.1093/icvts/ivv304pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.26/29460
dc.language.isoengpt_PT
dc.subjectInfective endocarditispt_PT
dc.subjectHeart surgerypt_PT
dc.subjectRisk stratificationpt_PT
dc.subjectPortugalpt_PT
dc.titleAssessment of perioperative mortality risk in patients with infective endocarditis undergoing cardiac surgery: performance of the EuroSCORE I and II logistic modelspt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage148pt_PT
oaire.citation.issue2pt_PT
oaire.citation.startPage141pt_PT
oaire.citation.volume22pt_PT
person.familyNameMarino Francisco Rodrigues
person.givenNameRicardo
person.identifier.ciencia-id1C16-3E73-D275
person.identifier.orcid0000-0001-5661-2928
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublicationeb7f3194-7ba1-4388-9e56-f7359a5daaf8
relation.isAuthorOfPublication.latestForDiscoveryeb7f3194-7ba1-4388-9e56-f7359a5daaf8

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