Key result
RISK-E score best predicts operative mortality in surgical infective endocarditis with an AUC of ~0.74.
Why the study?
The external validity and performance of prognostic models estimating operative mortality in patients undergoing surgery for infective endocarditis remain uncertain, limiting their clinical applicability.
Do infective endocarditis-specific risk scores accurately predict operative mortality in patients undergoing cardiac surgery for infective endocarditis?
Observational (n=689)
No
Do infective endocarditis-specific risk scores accurately predict operative mortality in patients undergoing cardiac surgery for infective endocarditis?
Effect estimate: AUC 0.742
The RISK-E score provides the most accurate prediction of operative mortality for patients undergoing surgery for infective endocarditis, outperforming generic cardiac surgery scores like EuroSCORE II.
RISK-E best discriminates operative mortality among validated IE scores; supports IE-specific tools but leaves open need for prospective confirmation before routine use.
Background: Several prognostic models have been developed to estimate operative mortality in patients undergoing surgery for infective endocarditis (IE). However, their external validity and performance remain uncertain, limiting clinical applicability. This study aimed to externally validate and compare the performance of contemporary IE-specific and generic cardiac surgery (EuroSCORE II) risk scores in a large single-center cohort. Methods: Eighteen operative IE-specific risk scores, along with EuroSCORE II, were retrospectively applied to a database of 689 patients undergoing cardiac surgery for IE. Discrimination was evaluated using the area under the receiver operating characteristic curve (AUC), while calibration was assessed using the Hosmer-Lemeshow test, Brier score, and calibration slopes/intercepts. For each score, the type of validation reported in the original study was critically examined, noting that validation was not always performed. Additionally, the inclusion of IE-specific variables, such as pathogen type and valvular complications, was assessed to evaluate the reliability and clinical applicability of each score. Results: Among the 689 patients, 30% were female, with a median age of 69 years. The most frequent pathogens were Streptococcus (26%), Staphylococcus aureus (18%), coagulase-negative staphylococci (18%), and Enterococcus faecalis (16%). Operative mortality was 10.6% (n = 73). The RISK-E score showed the highest discrimination (AUC: 0.742), followed by APORTEI (0.734) and modified MELD-XI (0.730). All scores demonstrated good calibration, with scaled Brier scores above 0.8. Scores incorporating IE-specific variables generally performed better, while several widely used generic scores, including EuroSCORE II, overestimated operative risk. External validation revealed lower AUCs for many scores compared to original reports, highlighting the importance of rigorous evaluation. Conclusion: The RISK-E score demonstrated the highest discriminative ability and satisfactory calibration for predicting operative mortality in patients undergoing surgery for infective endocarditis. These results support the role of externally validated, IE-specific prognostic tools in guiding clinical assessment and selecting appropriate perioperative strategies.
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A 2025 study conducted an observational in Infective endocarditis (n=689). IE-specific mortality prediction scores (e.g., RISK-E) vs. Generic cardiac surgery scores (e.g., EuroSCORE II) was evaluated on Discrimination for operative mortality (AUC) (AUC 0.742). The RISK-E score demonstrated the highest discriminative ability (AUC 0.742) for predicting operative mortality among 18 evaluated risk scores in patients undergoing surgery for infective endocarditis.
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