TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery
Key result
TRI-SCORE predicts in-hospital mortality after tricuspid valve surgery with rates reaching 60% for highest scores.
Why the study?
Isolated tricuspid valve surgery is considered high risk, but in-hospital mortality varies markedly, creating a need for a dedicated risk score to predict outcomes in severe tricuspid regurgitation.
Does the TRI-SCORE accurately predict in-hospital mortality in adult patients undergoing isolated tricuspid valve surgery for severe non-congenital tricuspid regurgitation?
Population
466 consecutive adult patients undergoing ITVS for severe non-congenital TR at 12 French centres
Design
Multicentre risk score derivation and internal validation study
Authors
Discussion
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Member takes
Implication
May inform preoperative risk stratification in isolated tricuspid valve surgery; hypothesis-generating and requires prospective validation.
Key Points
- The study aims to create a specific risk score to predict in-hospital mortality after isolated tricuspid valve surgery for severe tricuspid regurgitation.
- Included 466 consecutive adult patients from 12 French centers who underwent isolated tricuspid valve surgery for severe non-congenital tricuspid regurgitation from 2007 to 2017.
- Developed a scoring system based on 8 predictive parameters using multivariable logistic regression and validated with bootstrapping (1000 re-samples).
- Calculated areas under the receiver operating characteristic curve for the TRI-SCORE and compared it against the logistic EuroSCORE and EuroSCORE II.
- In-hospital mortality rate was 10% across the population studied.
- The TRI-SCORE showed an increased in-hospital mortality from 0% to 60% as scores ranged from 0 to ≥9 points, with predicted rates increasing from 1% to 65%.
- The area under the curve for TRI-SCORE was 0.81 (apparent) and 0.75 (bias-corrected), outperforming both EuroSCORE (0.67) and EuroSCORE II (0.63).
Structured PICO
Does the TRI-SCORE accurately predict in-hospital mortality in adult patients undergoing isolated tricuspid valve surgery for severe non-congenital tricuspid regurgitation?
P
Population
466 adult patients who underwent isolated tricuspid valve surgery (ITVS) for severe non-congenital tricuspid regurgitation (TR) at 12 French centres between 2007 and 2017. Mean age 60 ± 16 years, 49% female, functional TR in 49%.
I
Intervention
TRI-SCORE risk score model (an 8-parameter score including age ≥70 years, NYHA Class III–IV, right-sided heart failure signs, daily dose of furosemide ≥125 mg, eGFR <30 mL/min, elevated bilirubin, LVEF <60%, and moderate/severe right ventricular dysfunction)
C
Comparator
Logistic EuroSCORE and EuroSCORE II
O
Outcome
In-hospital mortalityhard clinical
The TRI-SCORE is a novel, 8-parameter clinical risk score that outperforms existing EuroSCORE models in predicting in-hospital mortality for patients undergoing isolated tricuspid valve surgery.
Cite This Study
Dreyfus et al. (2021) studied this question. The TRI-SCORE predicts in-hospital mortality after isolated tricuspid valve surgery, with mortality rates rising from 0% to 60% as scores increase from 0 to ≥9 points.