A pragmatic approach for mortality prediction after surgery in infective endocarditis: optimizing and refining EuroSCORE
| Autor: | B. Miranda, A. Santos-Ortega, María Luisa Aznar, Nuria Fernández-Hidalgo, J.M. Lomas, Juan Gálvez-Acebal, Josep Ramon Marsal, Gemma Sánchez-Espín, Emilio García-Cabrera, J. de la Torre-Lima, Marcela Castro, Pilar Tornos, A. de Alarcón, N. Vallejo, Benito Almirante, Aida Ribera, José María Reguera-Iglesias, I. Ferreria-González, David Garcia-Dorado, Carmen Hidalgo-Tenorio |
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| Přispěvatelé: | Ministerio de Economía y Competitividad (España), Instituto de Salud Carlos III, European Commission, Red Española de Investigación en Patología Infecciosa, Sociedad Española de Cardiología, Societat Catalana de Cardiologia |
| Rok vydání: | 2017 |
| Předmět: |
Microbiology (medical)
Male medicine.medical_specialty 030204 cardiovascular system & hematology Risk Assessment 03 medical and health sciences 0302 clinical medicine Euroscore ii Postoperative Complications Risk Factors Medicine Humans Preoperative state 030212 general & internal medicine Mortality prediction Hospital Mortality Mortality Cardiac Surgical Procedures Retrospective Studies Endocarditis business.industry EuroSCORE General Medicine Endocarditis Bacterial Middle Aged Prognosis medicine.disease Surgery Cardiac surgery Infectious Diseases Brier score Infective endocarditis Female business |
| Zdroj: | Digital.CSIC. Repositorio Institucional del CSIC instname Clinical Microbiology and Infection r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol |
| ISSN: | 1469-0691 1198-743X |
| Popis: | [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. This work was supported by the Ministerio de Economía y Competitividad, Instituto de Salud Carlos III—co-financed by European Development Regional Fund A way to achieve Europe ERDF, Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015); Catalan Society of Cardiology (Grant Orion Pharma); and Spanish Society of Cardiology. |
| Databáze: | OpenAIRE |
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