Hospital de Clínicas de Porto Alegre, Porto Alegre (HCPA), RS - Brasil.
Hospital Nossa Senhora da Conceição (HNSC), Porto Alegre, RS - Brasil.
Arq Bras Cardiol. 2024 Mar 4;120(12):e20230441. doi: 10.36660/abc.20230441. eCollection 2024.
Central Illustration : Performance of the SHARPEN Score and the Charlson Comorbidity Index for In-Hospital and Post-Discharge Mortality Prediction in Infective Endocarditis.
SHARPEN was the first dedicated score for in-hospital mortality prediction in infective endocarditis (IE) regardless of cardiac surgery.
To analyze the ability of the SHARPEN score to predict in-hospital and post-discharge mortality and compare it with that of the Charlson comorbidity index (CCI).
Retrospective cohort study including definite IE (Duke modified criteria) admissions from 2000 to 2016. The area under the ROC curve (AUC-ROC) was calculated to assess predictive ability. Kaplan-Meier curves and Cox regression was performed. P-value < 0.05 was considered statistically significant.
We studied 179 hospital admissions. In-hospital mortality was 22.3%; 68 (38.0%) had cardiac surgery. Median (interquartile range, IQR) SHARPEN and CCI scores were 9(7-11) and 3(2-6), respectively. SHARPEN had better in-hospital mortality prediction than CCI in non-operated patients (AUC-ROC 0.77 vs. 0.62, p = 0.003); there was no difference in overall (p = 0.26) and in operated patients (p = 0.41). SHARPEN > 10 at admission was associated with decreased in-hospital survival in the overall (HR 3.87; p < 0.001), in non-operated (HR 3.46; p = 0.006) and operated (HR 6.86; p < 0.001) patients. CCI > 3 at admission was associated with worse in-hospital survival in the overall (HR 3.0; p = 0.002), and in operated patients (HR 5.57; p = 0.005), but not in non-operated patients (HR 2.13; p = 0.119). Post-discharge survival was worse in patients with SHARPEN > 10 (HR 3.11; p < 0.001) and CCI > 3 (HR 2.63; p < 0.001) at admission; however, there was no difference in predictive ability between these groups.
SHARPEN was superior to CCI in predicting in-hospital mortality in non-operated patients. There was no difference between the scores regarding post-discharge mortality.
中心插图：SHARPEN 评分和 Charlson 合并症指数在感染性心内膜炎住院和出院后死亡率预测中的表现。
SHARPEN 是第一个专门用于预测感染性心内膜炎（IE）住院死亡率的评分，无论是否进行心脏手术。
分析 SHARPEN 评分预测住院和出院后死亡率的能力，并与 Charlson 合并症指数（CCI）进行比较。
回顾性队列研究纳入 2000 年至 2016 年期间确诊的 IE（杜克改良标准）住院患者。计算受试者工作特征曲线下面积（AUC-ROC）以评估预测能力。绘制 Kaplan-Meier 曲线和 Cox 回归。P 值<0.05 被认为具有统计学意义。
我们研究了 179 例住院患者。住院死亡率为 22.3%；68 例（38.0%）接受了心脏手术。SHARPEN 和 CCI 评分的中位数（四分位距，IQR）分别为 9（7-11）和 3（2-6）。SHARPEN 在非手术患者中的住院死亡率预测优于 CCI（AUC-ROC 0.77 与 0.62，p=0.003）；在总体患者（p=0.26）和手术患者（p=0.41）中无差异。入院时 SHARPEN>10 与总体（HR 3.87；p<0.001）、非手术（HR 3.46；p=0.006）和手术（HR 6.86；p<0.001）患者的住院生存率降低相关。入院时 CCI>3 与总体（HR 3.0；p=0.002）和手术患者（HR 5.57；p=0.005）的住院生存率较差相关，但与非手术患者（HR 2.13；p=0.119）无关。入院时 SHARPEN>10（HR 3.11；p<0.001）和 CCI>3（HR 2.63；p<0.001）的患者出院后生存率较差；然而，这些组之间在预测能力方面没有差异。
SHARPEN 在预测非手术患者住院死亡率方面优于 CCI。两组在出院后死亡率方面没有差异。
