Pivatto Júnior Fernando, Bellagamba Clarissa Carmona de Azevedo, Pianca Eduardo Gatti, Fernandes Fernando Schmidt, Butzke Maurício, Busato Stefano Boemler, Gus Miguel
Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.
Arq Bras Cardiol. 2020 May-Jun;114(3):518-524. doi: 10.36660/abc.20190050.
Risk scores are available for use in daily clinical practice, but knowing which one to choose is still fraught with uncertainty.
To assess the logistic EuroSCORE, EuroSCORE II, and the infective endocarditis (IE)-specific scores STS-IE, PALSUSE, AEPEI, EndoSCORE and RISK-E, as predictors of hospital mortality in patients undergoing cardiac surgery for active IE at a tertiary teaching hospital in Southern Brazil.
Retrospective cohort study including all patients aged ≥ 18 years who underwent cardiac surgery for active IE at the study facility from 2007-2016. The scores were assessed by calibration evaluation (observed/expected [O/E] mortality ratio) and discrimination (area under the ROC curve [AUC]). Comparison of AUC was performed by the DeLong test. A p < 0.05 was considered statistically significant.
A total of 107 patients were included. Overall hospital mortality was 29.0% (95%CI: 20.4-37.6%). The best O/E mortality ratio was achieved by the PALSUSE score (1.01, 95%CI: 0.70-1.42), followed by the logistic EuroSCORE (1.3, 95%CI: 0.92-1.87). The logistic EuroSCORE had the highest discriminatory power (AUC 0.77), which was significantly superior to EuroSCORE II (p = 0.03), STS-IE (p = 0.03), PALSUSE (p = 0.03), AEPEI (p = 0.03), and RISK-E (p = 0.02).
Despite the availability of recent IE-specific scores, and considering the trade-off between the indexes, the logistic EuroSCORE seemed to be the best predictor of mortality risk in our cohort, taking calibration (O/E mortality ratio: 1.3) and discrimination (AUC 0.77) into account. Local validation of IE-specific scores is needed to better assess preoperative surgical risk. (Arq Bras Cardiol. 2020; 114(3):518-524).
风险评分可用于日常临床实践，但要知道选择哪一种仍然充满不确定性。
评估逻辑回归欧洲心脏手术风险评估系统（EuroSCORE）、欧洲心脏手术风险评估系统二代（EuroSCORE II）以及感染性心内膜炎（IE）特异性评分系统，即胸外科医师协会感染性心内膜炎评分（STS-IE）、葡萄牙心内膜炎评分系统（PALSUSE）、阿根廷心内膜炎预测指数（AEPEI）、EndoSCORE和RISK-E，作为巴西南部一家三级教学医院因活动性IE接受心脏手术患者住院死亡率的预测指标。
回顾性队列研究，纳入2007年至2016年在研究机构因活动性IE接受心脏手术的所有年龄≥18岁的患者。通过校准评估（观察到的/预期的[O/E]死亡率比值）和区分度（ROC曲线下面积[AUC]）对评分进行评估。通过德龙检验对AUC进行比较。p<0.05被认为具有统计学意义。
共纳入107例患者。总体住院死亡率为29.0%（95%CI：20.4-37.6%）。PALSUSE评分获得最佳O/E死亡率比值（1.01，95%CI：0.70-1.42），其次是逻辑回归欧洲心脏手术风险评估系统（1.3，95%CI：0.92-1.87）。逻辑回归欧洲心脏手术风险评估系统具有最高的区分度（AUC 0.77），显著优于欧洲心脏手术风险评估系统二代（p=0.03）、胸外科医师协会感染性心内膜炎评分（p=0.03）、葡萄牙心内膜炎评分系统（p=0.03）、阿根廷心内膜炎预测指数（p=0.03）和RISK-E（p=0.02）。
尽管有最新的IE特异性评分，并且考虑到各指标之间的权衡，但综合校准（O/E死亡率比值：1.3）和区分度（AUC 0.77）来看，逻辑回归欧洲心脏手术风险评估系统似乎是我们队列中死亡风险的最佳预测指标。需要对IE特异性评分进行本地验证，以更好地评估术前手术风险。（《巴西心脏病学杂志》。2020年；114(3)：518-524）
