What is the clinical evidence from this study?

Study design: Observational. Population: infective endocarditis (n=192). Intervention: Surgical risk scores. Primary outcome: in-hospital mortality.

January 27, 2019Open Access

Using surgical risk scores in nonsurgically treated infective endocarditis patients

Key Result

Five of 10 evaluated surgical risk scores showed satisfactory discriminatory power (AUC >0.70) for predicting in-hospital mortality in medically treated infective endocarditis.

Study Design

Type

Observational (n=192)

Multicenter

Yes

Structured PICO

Do surgical risk scores accurately predict in-hospital mortality in nonsurgically treated patients with infective endocarditis?

Population

192 patients with definite infective endocarditis who did not undergo valve surgery, evaluated for in-hospital mortality using surgical risk scores.

Exposure

Application of 10 surgical risk scores (6 specific for IE surgery, 3 general heart surgery, 1 for 6-month mortality in IE)

Outcome

In-hospital mortality prediction (assessed via calibration and discriminatory power/AUC)hard clinical

Five existing surgical risk scores demonstrate satisfactory discriminatory power (AUC >0.70) for predicting in-hospital mortality in patients with infective endocarditis managed medically without surgery.

Abstract

BACKGROUND: The accuracy of surgical scores in predicting in-hospital mortality for nonsurgically treated patients with infective endocarditis (IE) has not yet been explored. METHODS: Patients with definite IE who did not undergo valve surgery were selected from the database of seven French administrative areas (Association pour l'Étude et la Prévention de l'Endocardite Infectieuse AEPEI Registry, 2008). The patients were scored using (a) six systems specifically devised to predict in-hospital mortality after surgery for IE, (b) three commonly used risk scores for heart surgery, and (c) a risk score for predicting six-month mortality in IE after either surgery or medical therapy. Calibration (Hosmer-Lemeshow test) and discriminatory power (receiver operating characteristic ROC analysis) were assessed for each score. Areas under ROC curves were compared one-to-one (Hanley-McNeil method). RESULTS: A total of 192 patients (mean age, 65.2±15.2 years) were considered for analysis. There were 38 (19.8%) in-hospital deaths. Age >70 years (p=0.001), Staphylococcus aureus as causal agent (p=0.05), and severe sepsis (p=0.027) were independent predictors of in-hospital mortality. Despite many differences in the number and type of variables, all but two of the investigated scores showed good calibration (p>0.66). However, discriminatory power was satisfactory (area under ROC curve >0.70) only for three of the scores specific for IE and two of the scores used to predict mortality after cardiac surgery. CONCLUSIONS: Among the 10 surgical scores evaluated in this study, five could be adopted to predict in-hospital mortality even for IE patients receiving medical treatment only.