Division of Cardiac Surgery, Trieste University Hospital, Trieste, Italy.
Department of Thoracic and Cardiovascular Surgery, Jean Minjoz University Hospital, Besançon, France.
Hellenic J Cardiol. 2020 Jul-Aug;61(4):246-252. doi: 10.1016/j.hjc.2019.01.008. Epub 2019 Jan 26.
The accuracy of surgical scores in predicting in-hospital mortality for nonsurgically treated patients with infective endocarditis (IE) has not yet been explored.
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).
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.
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.
手术评分预测非手术治疗感染性心内膜炎（IE）患者院内死亡率的准确性尚未得到探索。
从七个法国行政区的数据库中选择未接受瓣膜手术的明确 IE 患者（感染性心内膜炎预防和研究协会[AEPEI]注册处，2008 年）。使用（a）专门设计用于预测 IE 手术后院内死亡率的六个系统，（b）三种常用于心脏手术的风险评分，以及（c）一种用于预测手术或药物治疗后 IE 六个月死亡率的风险评分，对患者进行评分。对每个评分进行校准（Hosmer-Lemeshow 检验）和判别能力（接受者操作特征[ROC]分析）评估。ROC 曲线下面积逐个比较（Hanley-McNeil 方法）。
共纳入 192 例患者（平均年龄 65.2±15.2 岁）进行分析。有 38 例（19.8%）院内死亡。年龄>70 岁（p=0.001）、金黄色葡萄球菌作为病原体（p=0.05）和严重脓毒症（p=0.027）是院内死亡率的独立预测因素。尽管调查评分的变量数量和类型存在许多差异，但除了两个评分外，所有评分的校准均较好（p>0.66）。然而，只有三个针对 IE 的评分和两个用于预测心脏手术后死亡率的评分具有令人满意的判别能力（ROC 曲线下面积>0.70）。
在本研究中评估的 10 个手术评分中，有 5 个可用于预测仅接受药物治疗的 IE 患者的院内死亡率。
