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Fernández-Cisneros A, Hernández-Meneses M, Llopis J, Sandoval E, Pereda D, Alcocer J, Barriuso C, Castellá M, Ambrosioni J, Pericàs JM, Vidal B, Falces C, Ibáñez C, Perdomo J, Rovira I, García-de-la-María C, Moreno A, Almela M, Perisinotti A, Dahl A, Castro P, Miró JM, Quintana E. Risk scores' performance and their impact on operative decision-making in left-sided endocarditis: a cohort study. Eur J Clin Microbiol Infect Dis 2023; 42:33-42. [PMID: 36346471 PMCID: PMC9816251 DOI: 10.1007/s10096-022-04516-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022]
Abstract
The accuracy 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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Affiliation(s)
- A. Fernández-Cisneros
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain
| | - M. Hernández-Meneses
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J. Llopis
- grid.5841.80000 0004 1937 0247Department of Genetics, Microbiology and Statistics, University of Barcelona, Barcelona, Spain
| | - E. Sandoval
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - D. Pereda
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - J. Alcocer
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain
| | - C. Barriuso
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain
| | - M. Castellá
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - J. Ambrosioni
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J. M. Pericàs
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain ,grid.411083.f0000 0001 0675 8654Liver Unit, Internal Medicine Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute of Research, CIBERehd, Barcelona, Spain
| | - B. Vidal
- grid.5841.80000 0004 1937 0247Cardiology Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C. Falces
- grid.5841.80000 0004 1937 0247Cardiology Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C. Ibáñez
- grid.5841.80000 0004 1937 0247Anesthesiology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J. Perdomo
- grid.5841.80000 0004 1937 0247Anesthesiology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - I. Rovira
- grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Anesthesiology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C. García-de-la-María
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A. Moreno
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M. Almela
- grid.5841.80000 0004 1937 0247Microbiology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A. Perisinotti
- grid.410458.c0000 0000 9635 9413Nuclear Medicine Department, Biomaterials and Nanomedicine (CIBER-BBN), Hospital Clinic-IDIBAPS, University of Barcelona & Biomedical Research Networking Center of Bioengineering, Barcelona, Spain
| | - A. Dahl
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - P. Castro
- grid.5841.80000 0004 1937 0247Internal Medicine Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J. M. Miró
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E. Quintana
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
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Nana M, Rigopoulos D, Lekakis J, Sunbul M, Tigen K, Ozen G, Durmus E, Kivrak T, Cincin A, Ozben B, Atas H, Direskeneli H, Basaran Y, Stevanovic A, Dekleva M, Trajic S, Paunovic N, Simic A, Khan S, Mushemi-Blake S, Jouhra F, Dennes W, Monaghan M, Melikian N, Shah A, Maceira Gonzalez AM, Lopez-Lereu M, Monmeneu J, Igual B, Estornell J, Boraita A, Kosmala W, Rojek A, Bialy D, Mysiak A, Przewlocka-Kosmala M, Popescu I, Mancas S, Mornos C, Serbescu I, Ionescu G, Ionac A, Gaudron P, Niemann M, Herrmann S, Hu K, Liu D, Wojciech K, Frantz S, Bijnens B, Ertl G, Weidemann F, Maceira Gonzalez AM, Cosin-Sales J, Ruvira J, Diago J, Aguilar J, Igual B, Lopez-Lereu M, Monmeneu J, Estornell J, Cruz C, Pinho T, Madureira A, Lebreiro A, Dias C, Ramos I, Silva Cardoso J, Julia Maciel M, De Meester P, Van De Bruaene A, Herijgers P, Voigt JU, Budts W, Franzoso F, Voser E, Wohlmut C, Kellenberger C, Valsangiacomo Buechel E, Carrero C, Benger J, Parcerisa M, Falconi M, Oberti P, Granja M, Cagide A, Del Pasqua A, Secinaro A, Antonelli G, Iacomino M, Toscano A, Chinali M, Esposito C, Carotti A, Pongiglione G, Rinelli G, Youssef Moustafa A, Al Murayeh M, Al Masswary A, Al Sheikh K, Moselhy M, Dardir M, Deising J, Butz T, Suermeci G, Liebeton J, Wennemann R, Tzikas S, Van Bracht M, Prull M, Trappe HJ, Martin Hidalgo M, Delgado Ortega M, Ruiz Ortiz M, Mesa Rubio D, Carrasco Avalos F, Seoane Garcia T, Pan Alvarez-Ossorio M, Lopez Aguilera J, Puentes Chiachio M, Suarez De Lezo Cruz Conde J, Petrovic MT, Giga V, Stepanovic J, Tesic M, Jovanovic I, Djordjevic-Dikic A, Generati G, Pellegrino M, Bandera F, Donghi V, Alfonzetti E, Guazzi M, Piatkowski R, Kochanowski J, Scislo P, Opolski G, Zagatina A, Zhuravskaya N, Krylova L, Vareldzhyan Y, Tyurina T, Clitsenko O, Bombardini T, Gherardi S, Leone O, Picano E, Michelotto E, Ciccarone A, Tarantino N, Ostuni V, Rubino M, Genco W, Santoro G, Carretta D, Romito R, Colonna P, Cameli M, Lunghetti S, Lisi M, Curci V, Cameli P, Focardi M, Favilli R, Galderisi M, Mondillo S, Hoffmann R, Barletta G, Von Bardeleben S, Kasprzak J, Greis C, Vanoverschelde J, Becher H, Machida T, Izumo M, Suzuki K, Kaimijima R, Mizukoshi K, Manabe-Uematsu M, Takai M, Harada T, Akashi Y, Martin Garcia A, Arribas-Jimenez A, Cruz-Gonzalez I, Nieto F, Iscar A, Merchan S, Martin-Luengo C, Brecht A, Theres L, Spethmann S, Dreger H, Baumann G, Knebel F, Jasaityte R, Heyde B, Rademakers F, Claus P, D'hooge J, Lervik Nilsen LC, Lund J, Brekke B, Stoylen A, Giraldeau G, Duchateau N, Gabrielli L, Penela D, Evertz R, Mont L, Brugada J, Berruezo A, Bijnens B, Sitges M, Kordybach M, Kowalski M, Hoffman P, Pilichowska E, Zaborska B, Baran J, Kulakowski P, Budaj A, Wahi S, Vollbon W, Leano R, Thomas A, Bricknell K, Holland D, Napier S, Stanton T, Teferici D, Qirko S, Petrela E, Dibra A, Bajraktari G, Bara P, Sanchis Ruiz L, Gabrielli L, Andrea R, Falces C, Duchateau N, Perez-Villa F, Bijnens B, Sitges M, Sulemane S, Panoulas V, Bratsas A, Tam F, Nihoyannopoulos P, Abduch M, Alencar A, Coracin F, Barban A, Saboya R, Dulley F, Mathias W, Vieira M, Buccheri S, Mangiafico S, Arcidiacono A, Bottari V, Leggio S, Tamburino C, Monte IP, Cruz C, Lebreiro A, Pinho T, Dias C, Silva Cardoso J, Julia Maciel M, Spitzer E, Beitzke D, Kaneider A, Pavo N, Gottsauner-Wolf M, Wolf F, Loewe C, Mushtaq S, Andreini D, Pontone G, Bertella E, Conte E, Baggiano A, Annoni A, Cortinovis S, Fiorentini C, Pepi M, Gustafsson M, Alehagen U, Dahlstrom U, Johansson P, Faden G, Faggiano P, Albertini L, Reverberi C, Gaibazzi N, Taylor RJ, Moody W, Umar F, Edwards N, Townend J, Steeds R, Leyva F, Mihaila S, Muraru D, Piasentini E, Peluso D, Casablanca S, Naso P, Puma L, Iliceto S, Vinereanu D, Badano L, Ciciarello FL, Agati L, Cimino S, De Luca L, Petronilli V, Fedele F, Tsverava M. Poster Session Saturday 14 December - AM: 14/12/2013, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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