Department of Cardio-Thoraco-Vascular, University of Trieste, Trieste, Italy.
Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.
Am Heart J. 2024 Sep;275:108-118. doi: 10.1016/j.ahj.2024.05.021. Epub 2024 Jun 6.
It remains unclear today whether risk scores created specifically to predict early mortality after cardiac operations for infective endocarditis (IE) outperform or not the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II).
Perioperative data and outcomes from a European multicenter series of patients undergoing surgery for definite IE were retrospectively reviewed. Only the cases with known pathogen and without missing values for all considered variables were retained for analyses. A comparative validation of EuroSCORE II and 5 specific risk scores for early mortality after surgery for IE-(1) STS-IE (Society of Thoracic Surgeons for IE); (2) PALSUSE (Prosthetic valve, Age ≥70, Large intracardiac destruction, Staphylococcus spp, Urgent surgery, Sex (female), EuroSCORE ≥10); (3) ANCLA (Anemia, New York Heart Association class IV, Critical state, Large intracardiac destruction, surgery on thoracic Aorta); (4) AEPEI II (Association pour l'Étude et la Prévention de l'Endocardite Infectieuse II); (5) APORTEI (Análisis de los factores PROnósticos en el Tratamiento quirúrgico de la Endocarditis Infecciosa)-was carried out using calibration plot and receiver-operating characteristic curve analysis. Areas under the curve (AUCs) were compared 1:1 according to the Hanley-McNeil's method. The agreement between APORTEI score and EuroSCORE II of the 30-day mortality prediction after surgery was also appraised.
A total of 1,012 patients from 5 European university-affiliated centers underwent 1,036 cardiac operations, with a 30-day mortality after surgery of 9.7%. All IE-specific risk scores considered achieved better results than EuroSCORE II in terms of calibration; AEPEI II and APORTEI score showed the best performances. Despite poor calibration, EuroSCORE II overcame in discrimination every specific risk score (AUC, 0.751 vs 0.693 or less, P = .01 or less). For a higher/lesser than 20% expected mortality, the agreement of prediction between APORTEI score and EuroSCORE II was 86%.
EuroSCORE II discrimination for 30-day mortality after surgery for IE was higher than 5 established IE-specific risk scores. AEPEI II and APORTEI score showed the best results in terms of calibration.
目前尚不清楚专门用于预测心脏手术治疗感染性心内膜炎（IE）后早期死亡率的风险评分是否优于欧洲心脏手术风险评估系统 II（EuroSCORE II）。
回顾性分析了一项来自欧洲多中心的接受明确 IE 手术治疗的患者的围手术期数据和结局。仅保留已知病原体且所有考虑变量均无缺失值的病例进行分析。使用校准图和接收者操作特征曲线分析对 EuroSCORE II 和 5 种特定的 IE 手术后早期死亡率风险评分（1）STS-IE（胸外科医师学会 IE）；（2）PALSUSE（人工瓣膜，年龄≥70 岁，心内大量破坏，金黄色葡萄球菌，紧急手术，女性，EuroSCORE≥10）；（3）ANCLA（贫血，纽约心脏协会心功能 IV 级，危急状态，心内大量破坏，胸主动脉手术）；（4）AEPEI II（感染性心内膜炎研究和预防协会 II）；（5）APORTEI（分析感染性心内膜炎手术治疗的预后因素）进行了比较。根据 Hanley-McNeil 方法，以 1:1 的比例比较曲线下面积（AUCs）。还评估了 APORTEI 评分与 EuroSCORE II 对手术后 30 天死亡率的预测一致性。
来自 5 个欧洲大学附属中心的共 1012 名患者接受了 1036 次心脏手术，手术后 30 天死亡率为 9.7%。在评估的所有 IE 特定风险评分中，在校准方面均优于 EuroSCORE II；AEPEI II 和 APORTEI 评分表现最佳。尽管校准不佳，但 EuroSCORE II 在区分力方面优于每个特定风险评分（AUC，0.751 比 0.693 或更低，P≤0.01）。对于预期死亡率高于/低于 20%的情况，APORTEI 评分和 EuroSCORE II 之间的预测一致性为 86%。
EuroSCORE II 对 IE 手术后 30 天死亡率的区分力高于 5 种已建立的 IE 特定风险评分。AEPEI II 和 APORTEI 评分在校准方面表现最佳。
