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Título: | A pragmatic approach for mortality prediction after surgery in infective endocarditis: optimizing and refining EuroSCORE |
Autor: | Fernández-Hidalgo, N.; Ferreria-González, I.; Marsal, J. R.; Ribera, A.; Aznar, M. L.; Alarcón González, Arístides de CSIC ORCID; García-Cabrera, Emilio; Gálvez-Acebal, Juan CSIC ORCID CVN; Sánchez-Espín, G.; Reguera-Iglesias, J. M.; Torre, Javier de la; Lomas-Cabezas, José Manuel CSIC; Hidalgo-Tenorio, Carmen; Vallejo, N.; Miranda, B.; Santos-Ortega, A.; Castro, M. A.; Tornos, P.; García-Dorado, David; Almirante, Benito | Palabras clave: | EuroSCORE Infective endocarditis Mortality Prognosis Surgery |
Fecha de publicación: | oct-2018 | Editor: | Elsevier | Citación: | Clinical Microbiology and Infection 24(10): 1102.e7-1102.e15 (2018) | Resumen: | [Objective] To simplify and optimize the ability of EuroSCORE I and II to predict early mortality after surgery for infective endocarditis (IE). [Methods] Multicentre retrospective study (n = 775). Simplified scores, eliminating irrelevant variables, and new specific scores, adding specific IE variables, were created. The performance of the original, recalibrated and specific EuroSCOREs was assessed by Brier score, C-statistic and calibration plot in bootstrap samples. The Net Reclassification Index was quantified. [Results] Recalibrated scores including age, previous cardiac surgery, critical preoperative state, New York Heart Association >I, and emergent surgery (EuroSCORE I and II); renal failure and pulmonary hypertension (EuroSCORE I); and urgent surgery (EuroSCORE II) performed better than the original EuroSCOREs (Brier original and recalibrated: EuroSCORE I: 0.1770 and 0.1667; EuroSCORE II: 0.2307 and 0.1680). Performance improved with the addition of fistula, staphylococci and mitral location (EuroSCORE I and II) (Brier specific: EuroSCORE I 0.1587, EuroSCORE II 0.1592). Discrimination improved in specific models (C-statistic original, recalibrated and specific: EuroSCORE I: 0.7340, 0.7471 and 0.7728; EuroSCORE II: 0.7442, 0.7423 and 0.7700). Calibration improved in both EuroSCORE I models (intercept 0.295, slope 0.829 (original); intercept –0.094, slope 0.888 (recalibrated); intercept –0.059, slope 0.925 (specific)) but only in specific EuroSCORE II model (intercept 2.554, slope 1.114 (original); intercept –0.260, slope 0.703 (recalibrated); intercept –0.053, slope 0.930 (specific)). Net Reclassification Index was 5.1% and 20.3% for the specific EuroSCORE I and II. [Conclusions] The use of simplified EuroSCORE I and EuroSCORE II models in IE with the addition of specific variables may lead to simpler and more accurate models. |
Versión del editor: | http://dx.doi.org/10.1016/j.cmi.2018.01.019 | URI: | http://hdl.handle.net/10261/198845 | DOI: | 10.1016/j.cmi.2018.01.019 | Identificadores: | doi: 10.1016/j.cmi.2018.01.019 e-issn: 1469-0691 issn: 1198-743X |
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