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Gatti G, Fiore A, Ismail M, Dralov A, Saade W, Costantino V, Barbati G, Lim P, Lepeule R, Franzese I, Minati A, Sponga S, Fabris E, Luzzati R, Sinagra G, Biondi-Zoccai G, Frati G, Perrotti A, Vendramin I, Mazzaro E. Prediction of 30-day mortality after surgery for infective endocarditis using risk scores: Insights from a European multicenter comparative validation study. Am Heart J 2024; 275:108-118. [PMID: 38848985 DOI: 10.1016/j.ahj.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND 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). METHODS 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. RESULTS 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%. CONCLUSION 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.
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Affiliation(s)
- Giuseppe Gatti
- Department of Cardio-Thoraco-Vascular, University of Trieste, Trieste, Italy.
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Maria Ismail
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz and University of Franche-Comté, Besançon, France
| | - Andriy Dralov
- Department of Cardiac Surgery, Ospedale Santa Maria della Misericordia, Udine, Italy
| | - Wael Saade
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, La Sapienza University, Rome, Italy
| | | | - Giulia Barbati
- Department of Medical Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy
| | - Pascal Lim
- Department of Cardiology, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Faculté de Santé, Université de Paris Est, Créteil, France
| | - Raphael Lepeule
- Unitée Transversale de Traitement des Infections, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Ilaria Franzese
- Department of Cardio-Thoraco-Vascular, University of Trieste, Trieste, Italy
| | - Alessandro Minati
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, La Sapienza University, Rome, Italy
| | - Sandro Sponga
- Department of Cardiac Surgery, Ospedale Santa Maria della Misericordia, Udine, Italy
| | - Enrico Fabris
- Department of Cardio-Thoraco-Vascular, University of Trieste, Trieste, Italy
| | - Roberto Luzzati
- Department of Infective Diseases, University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Department of Cardio-Thoraco-Vascular, University of Trieste, Trieste, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical Surgical Sciences and Biotechnologies, La Sapienza University, Rome, Italy; Cardiology Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Giacomo Frati
- Department of Medical Surgical Sciences and Biotechnologies, La Sapienza University, Rome, Italy; Department of Angio-Cardio-Neurology, IRCCS Neuromed, Pozzilli, Italy
| | - Andrea Perrotti
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz and University of Franche-Comté, Besançon, France
| | - Igor Vendramin
- Department of Cardiac Surgery, Ospedale Santa Maria della Misericordia, Udine, Italy
| | - Enzo Mazzaro
- Department of Cardio-Thoraco-Vascular, University of Trieste, Trieste, Italy
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Wei X, Ran P, Nong Y, Ye T, Jian X, Yao Y, Xu Y, Li Y, Wang Z, Yang J, Wang S, Yu D, Chen J. ASSESS-IE: a Novel Risk Score for Patients with Infective Endocarditis. J Cardiovasc Transl Res 2024; 17:695-704. [PMID: 37966632 DOI: 10.1007/s12265-023-10456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
Mortality in patients with infective endocarditis (IE) remains high. The existing risk scores are relatively complex with limited clinical application. This study was conducted to establish a new risk model to predict in-hospital and 6-month mortality in IE patients. A total of 1549 adult patients with definite IE admitted to Guangdong Provincial People's Hospital (n=1354) or Xiamen Cardiovascular Hospital (n=195) were included. The derivation cohort consisted of 1141 patients. The score was developed using the multivariate stepwise logistic regression analysis for in-hospital death. Bootstrap analysis was used for validation. Discrimination and calibration were evaluated by the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test. Six risk factors were used as score parameters (1 point for each): aortic valve affected, previous valve replacement surgery, severe heart failure, elevated serum direct bilirubin, moderate-severe anemia and acute stage. The predictive value and calibration of the ASSESS-IE score for in-hospital death were excellent in the derivation (area under the curve [AUC]=0.781, p<0.001; Hosmer-Lemeshow p=0.948) and validation (AUC=0.779, p<0.001; Hosmer-Lemeshow p=0.520) cohorts. The score remained excellent in bootstrap validation (AUC=0.783). The discriminatory ability of the ASSESS-IE score for in-hospital (AUC: 0.781 vs. 0.799, p=0.398) and 6-month mortality (AUC: 0.778 vs. 0.814, p=0.040) were similar with that of Park's score which comprised 14 variables. The ASSESS-IE risk score is a new and robust risk-stratified tool for patients with IE, which might further facilitate clinical decision-making.
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Affiliation(s)
- Xuebiao Wei
- Division of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Peng Ran
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Yuxin Nong
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Tao Ye
- Division of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, Xiamen, 361004, China
| | - Xuhua Jian
- Division of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Younan Yao
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Yiwei Xu
- Division of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, Xiamen, 361004, China
| | - Yang Li
- Division of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, Xiamen, 361004, China
| | - Zhonghua Wang
- Division of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Junqing Yang
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Shouhong Wang
- Division of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
| | - Danqing Yu
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
| | - Jiyan Chen
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
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Varela-Barca L, López-Menéndez J. Perioperative risk stratification scores in infective endocarditis and its usefulness. Indian J Thorac Cardiovasc Surg 2024; 40:47-60. [PMID: 38827549 PMCID: PMC11139811 DOI: 10.1007/s12055-023-01644-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 06/04/2024] Open
Abstract
Infective endocarditis continues to represent a serious disease worldwide with high morbidity and mortality rates despite advances in diagnosis and treatment. Risk assessment plays a pivotal role in determining the appropriate course of treatment for patients diagnosed with infective endocarditis. In this context, specific endocarditis risk scores have been developed trying to help in the risk assessment process. During the last 15 years, 19 specific endocarditis scores have been published. These newly created scores are very heterogenous in their characteristics, factors included, and validation strategies. The purpose of this review is to analyze the published specific infective endocarditis risk scores and discuss their advantages, limitations, and usefulness. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-023-01644-y.
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Affiliation(s)
- Laura Varela-Barca
- Cardiac Surgery Department, La Princesa University Hospital, Madrid, Spain
| | - Jose López-Menéndez
- Cardiac Surgery Department, Ramón y Cajal University Hospital, Madrid, Spain
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Leterrier J, Iung B, de Tymoski C, Deconinck L, Para M, Duval X, Provenchere S, Mesnier J, Delhomme C, Haviari S, Urena M, Suc G. Sex differences and outcomes in surgical infective endocarditis. Eur J Cardiothorac Surg 2024; 65:ezae114. [PMID: 38521543 DOI: 10.1093/ejcts/ezae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Cardiac surgery for infective endocarditis (IE) is associated with significant hospital mortality, and female sex may be associated with worse outcomes. However, the impact of sex on the presenting characteristics, management, and outcomes of patients operated on for acute infective endocarditis (IE) has not been adequately studied. OBJECTIVES The goal of our study was to analyse differences in management and outcome of IE between women and men who undergo surgery. METHODS Clinical data of 717 patients undergoing cardiac surgery for IE between December 2005 and December 2019 were prospectively collected. Sex-related postoperative outcomes including in-hospital mortality were recorded. Univariable and multivariable analyses were performed to identify potential sex-related determinant of in-hospital mortality. RESULTS In all, 532 male patients (74.2%) and 185 female patients (25.8%) underwent surgery for IE. At baseline, women had more frequent mitral regurgitation with 63 patients (34.1%) than men with 135 patients (25.4%) (P = 0.002). Female sex was associated with higher in-hospital mortality (23.2% versus 17.3%, P = 0.049). However, multivariable analysis revealed age (P < 0.01), antibiotics < 7 days before surgery (P = 0.01) and staphylococcal IE (P < 0.01) but not female sex (P = 0.99) as independent determinants of hospital mortality. CONCLUSIONS In this study of patients operated-on for IE, female sex was associated with more severe manifestations of IE and significantly higher in-hospital mortality. However, after multivariable analysis, initial presentation, but not sex, seemed to determine clinical outcomes.
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Affiliation(s)
| | - Bernard Iung
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
| | - Christian de Tymoski
- Université Paris Cité, Paris, France
- Cardiac Surgery, Bichat Hospital, AP-HP, Paris, France
- Inserm CIC 1425, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
| | - Laurene Deconinck
- Université Paris Cité, Paris, France
- Infectious Diseases Department, Bichat Hospital, APHP, Paris, France
| | - Marylou Para
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
- Cardiac Surgery, Bichat Hospital, AP-HP, Paris, France
| | - Xavier Duval
- Université Paris Cité, Paris, France
- Inserm CIC 1425, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
- Inserm, UMR-1137, IAME, Paris, France
| | - Sophie Provenchere
- Inserm CIC 1425, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
- Anesthesia and Critical Care Department, DMU Parabol, Bichat Claude Bernard University Hospital, APHP, Paris, France
| | - Jules Mesnier
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
| | | | - Skerdi Haviari
- Université Paris Cité, Paris, France
- Epidemiology Biostatistics & Clinical Research Department, Bichat, APHP, Paris, France
- UPC-Inserm UMR1137 IAME, Paris, France
| | - Marina Urena
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
| | - Gaspard Suc
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
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Che D, Hu J, Zhu J, Lyu J, Zhang X. Development and validation of a nomogram for predicting in-hospital mortality in ICU patients with infective endocarditis. BMC Med Inform Decis Mak 2024; 24:84. [PMID: 38515185 PMCID: PMC10958908 DOI: 10.1186/s12911-024-02482-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a disease with high in-hospital mortality. The objective of the present investigation was to develop and validate a nomogram that precisely anticipates in-hospital mortality in ICU individuals diagnosed with infective endocarditis. METHODS Retrospectively collected clinical data of patients with IE admitted to the ICU in the MIMIC IV database were analyzed using the Least Absolute Shrinkage and Selection Operator (LASSO) regression to identify potential hazards. A logistic regression model incorporating multiple factors was established, and a dynamic nomogram was generated to facilitate predictions. To assess the classification performance of the model, an ROC curve was generated, and the AUC value was computed as an indicator of its diagnostic accuracy. The model was subjected to calibration curve analysis and the Hosmer-Lemeshow (HL) test to assess its goodness of fit. To evaluate the clinical relevance of the model, decision-curve analysis (DCA) was conducted. RESULTS The research involved a total of 676 patients, who were divided into two cohorts: a training cohort comprising 473 patients and a validation cohort comprising 203 patients. The allocation ratio between the two cohorts was 7:3. Based on the independent predictors identified through LASSO regression, the final selection for constructing the prediction model included five variables: lactate, bicarbonate, white blood cell count (WBC), platelet count, and prothrombin time (PT). The nomogram model demonstrated a robust diagnostic ability in both the cohorts used for training and validation. This is supported by the respective area under the curve (AUC) values of 0.843 and 0.891. The results of the calibration curves and HL tests exhibited acceptable conformity between observed and predicted outcomes. According to the DCA analysis, the nomogram model demonstrated a notable overall clinical advantage compared to the APSIII and SAPSII scoring systems. CONCLUSIONS The nomogram developed during the study proved to be highly accurate in forecasting the mortality of patients with IE during hospitalization in the ICU. As a result, it may be useful for clinicians in decision-making and treatment.
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Affiliation(s)
- Dongyang Che
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, Guangdong Province, People's Republic of China
| | - Jinlin Hu
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Guangzhou, Guangdong Provincial Hospital of Chinese Medicine, University of Chinese Medicine, 510630, Guangzhou, Guangdong Province, People's Republic of China
| | - Jialiang Zhu
- The First Affiliated Hospital of Jinan University, 510630, Guangzhou, Guangdong Province, People's Republic of China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, Guangdong Province, People's Republic of China.
| | - Xiaoshen Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, Guangdong Province, People's Republic of China.
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Alves SG, Pivatto F, Filippini FB, Dannenhauer GP, Seroiska G, Bischoff HM, Birk LFS, Terra DH, Sganzerla D, Miglioranza MH. Performance of the SHARPEN Score and the Charlson Comorbidity Index for In-Hospital and Post-Discharge Mortality Prediction in Infective Endocarditis. Arq Bras Cardiol 2024; 120:e20230441. [PMID: 38451614 PMCID: PMC11021123 DOI: 10.36660/abc.20230441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Central Illustration : Performance of the SHARPEN Score and the Charlson Comorbidity Index for In-Hospital and Post-Discharge Mortality Prediction in Infective Endocarditis. BACKGROUND SHARPEN was the first dedicated score for in-hospital mortality prediction in infective endocarditis (IE) regardless of cardiac surgery. OBJECTIVES 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). METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Sofia Giusti Alves
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasilHospital de Clínicas de Porto Alegre, Porto Alegre (HCPA), RS – Brasil
| | - Fernando Pivatto
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasilHospital de Clínicas de Porto Alegre, Porto Alegre (HCPA), RS – Brasil
- Hospital Nossa Senhora da ConceiçãoPorto AlegreRSBrasilHospital Nossa Senhora da Conceição (HNSC), Porto Alegre, RS – Brasil
| | - Filippe Barcellos Filippini
- Instituto de Cardiologia de Santa CatarinaSão JoséSCBrasilInstituto de Cardiologia de Santa Catarina, São José, SC – Brasil
| | - Gustavo Paglioli Dannenhauer
- Instituto de Cardiologia de Santa CatarinaSão JoséSCBrasilInstituto de Cardiologia de Santa Catarina, São José, SC – Brasil
| | - Gabriel Seroiska
- Universidade Federal de Ciências da Saúde de Porto AlegrePorto AlegreRSBrasilUniversidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS – Brasil
| | - Helena Marcon Bischoff
- Universidade Federal de Ciências da Saúde de Porto AlegrePorto AlegreRSBrasilUniversidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS – Brasil
| | - Luiz Felipe Schmidt Birk
- Universidade Federal de Ciências da Saúde de Porto AlegrePorto AlegreRSBrasilUniversidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS – Brasil
| | - Diego Henrique Terra
- Universidade Federal de Ciências da Saúde de Porto AlegrePorto AlegreRSBrasilUniversidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS – Brasil
| | - Daniel Sganzerla
- Unimed Porto Alegre Cooperativa MédicaPorto AlegreRSBrasilUnimed Porto Alegre Cooperativa Médica, Porto Alegre, RS – Brasil
| | - Marcelo Haertel Miglioranza
- Universidade Federal de Ciências da Saúde de Porto AlegrePorto AlegreRSBrasilUniversidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS – Brasil
- Unimed Porto Alegre Cooperativa MédicaPorto AlegreRSBrasilUnimed Porto Alegre Cooperativa Médica, Porto Alegre, RS – Brasil
- Instituto de Cardiologia do Rio Grande do SulLaboratório de Pesquisa e Inovação em Imagem CardiovascularPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul (ICFUC-RS) – Laboratório de Pesquisa e Inovação em Imagem Cardiovascular, Porto Alegre, RS – Brasil
- Hospital Mãe de DeusPorto AlegreRSBrasilHospital Mãe de Deus, Porto Alegre, RS – Brasil
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El Hatimi S, Erpelding ML, Selton-Suty C, Botros JB, Goehringer F, Berthelot E, Elfarra M, Deconinck L, Para M, Provenchere S, Hoen B, Agrinier N, Duval X, Iung B. Predictive performance of surgical mortality risk scores in infective endocarditis. Eur J Cardiothorac Surg 2024; 65:ezad433. [PMID: 38175782 DOI: 10.1093/ejcts/ezad433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/14/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES This observational study aimed to evaluate Association pour l'Etude et la Prévention de l'Endocardite Infectieuse (AEPEI) surgery score predictive performance in comparison to general (EuroSCORE I, II) and specific (De Feo, PALSUSE) surgical risk scores for infective endocarditis (IE). METHODS The study included patients who underwent surgery for IE during the acute phase at Bichat University Hospital (Paris, France) between 1 January 2006 and 31 December 2016 and at Nancy University Hospital (Nancy, France) between 1 January 2009 and 31 December 2019. Patients with IE complicating percutaneous aortic valve implantations or implantable intra-cardiac devices were excluded. Discrimination and calibration were assessed using receiver operating characteristic curve analysis, calibration curves and the Hosmer-Lemeshow test. RESULTS In-hospital mortality rates were 18% at Bichat and 16% at Nancy. Discrimination was high for all risk scores at Bichat (area under the receiver operating characteristic curve = 0.77 for EuroSCORE I, 0.78 for EuroSCORE II, 0.76 for De Feo score, 0.72 for PALSUSE and 0.73 for AEPEI with 95% confidence interval ranging from 0.67 to 0.83), but lower at Nancy (0.56 for EuroSCORE I, 0.65 for EuroSCORE II, 0.63 for De Feo score, 0.67 for PALSUSE and 0.66 for AEPEI score with 95% confidence interval ranging from 0.47 to 0.75). With Brier score, all scores were adequately calibrated in both populations between 0.129 (De Feo) and 0.135 (PALSUSE) for Bichat and between 0.128 (De Feo) and 0.135 (EuroSCORE I) for Nancy. With the Hosmer-Lemeshow test, the AEPEI score exhibited the best calibration (observed/predicted ratio 1.058 in Bichat, 1.087 in Nancy). CONCLUSIONS This surgical score external validation in 2 large independent populations demonstrated that the AEPEI surgical score had the best predictive performance compared to other prognosis scores. It could be helpful in clinical practice to assist the endocarditis team in decision-making.
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Affiliation(s)
- Safwane El Hatimi
- Cardiology Department, Université Paris-Saclay, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Marie-Line Erpelding
- Clinical Epidemiology Department, Université de Lorraine CHRU Nancy, INSERM, CIC, Nancy, France
| | | | - Jean-Baptiste Botros
- Cardiology Department, Université Paris-Cité, AP-HP, Hôpital Bichat, Paris, France
| | - François Goehringer
- Infectious and Tropical Diseases Department, Université de Lorraine CHRU Nancy, Nancy, France
| | - Emmanuelle Berthelot
- Cardiology Department, Université Paris-Saclay, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Mazen Elfarra
- Cardiac Surgery Department, Université de Lorraine CHRU Nancy, Nancy, France
| | - Laurène Deconinck
- Infectious and Tropical Diseases Department, Université Paris-Cité, AP-HP, Hôpital Bichat, Paris, France
| | - Marylou Para
- Cardiac Surgery Department, Université Paris-Cité, AP-HP, Hôpital Bichat, Paris, France
| | - Sophie Provenchere
- Anaesthesiology Department, Université Paris-Cité, AP-HP, Hôpital Bichat, Paris, France
| | - Bruno Hoen
- Infectious and Tropical Diseases Department, Université de Lorraine CHRU Nancy, Nancy, France
| | - Nelly Agrinier
- Clinical Epidemiology Department, Université de Lorraine CHRU Nancy, INSERM, CIC, Nancy, France
| | - Xavier Duval
- Infectious and Tropical Diseases Department, Université Paris-Cité, AP-HP, Hôpital Bichat, Paris, France
- Inserm CIC 1425, IAME, Paris, France
| | - Bernard Iung
- Cardiology Department, Université Paris-Cité, AP-HP, Hôpital Bichat, Paris, France
- Inserm U1148, Laboratory for Vascular Translational Science, Paris, France
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8
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 226] [Impact Index Per Article: 226.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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9
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Kalkan AK, Kahraman S, Demirci G, Agus HZ, Oner E, Kalkan K, Yıldız M. In-hospital outcomes of patients undergoing emergent surgical treatment in patients with infective endocarditis. ULUS TRAVMA ACIL CER 2023; 29:996-1003. [PMID: 37681726 PMCID: PMC10560818 DOI: 10.14744/tjtes.2023.23162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/05/2023] [Accepted: 06/07/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Infective endocarditis is a serious heart disease that may cause several different clinical conditions and can need urgent surgical therapy. In our study, we aimed to evaluate the patients with infective endocarditis undergoing acute surgical treatment results in-hospital mortality. METHODS A total of 107 consecutive patients with infective endocarditis undergoing acute surgical therapy were included in our retrospective study. The patients were divided into two groups according to the presence of in-hospital mortality as Group 1 without in-hospital mortality (n=89) and Group 2 with in-hospital mortality (n=18). The demographic, laboratory, and clinical parameters were evaluated in both groups. RESULTS The mean age (50±14; 64±14, P<0.001) and the incidence of chronic renal failure (9 [10.1%]; 8 [44.4%], P=0.001) were higher in Group 2 while the ejection fraction was lower in Group 2 (50.0±9.3; 44.6±12.9, P=0.039). The incidence of positive blood culture was also higher in Group 2 (41 [46.1]; 14 [77.8], P=0.014). Aortic bioprosthesis operation (2 [2.2]; 6 [33.3], P<0.001) and mitral bioprosthesis operation (4 [4.5]; 5 [27.8], P=0.008) were higher in Group 2 as well as the incidence of septic shock was also higher in Group 2 (1 [1.1]; 3 [16.7], P=0.015). In addition, in multivariate logistic regression analyses, advanced age (odds ratio [OR]: 1.068, 95% confidence interval [CI]: 1.009-1.130, P: 0.024) and positive blood culture (OR: 4.436, 95% CI: 1.044-18.848, P: 0.044) were found to be independent predictors of in-hospital mortality. CONCLUSION Advanced age, lower ejection fraction, high creatinine, positive blood culture, high systolic pulmonary artery pressure, and septic shock predicted in-hospital death in patients who have undergone emergent or urgent surgery due to infective endocarditis.
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Affiliation(s)
- Ali Kemal Kalkan
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul-Türkiye
| | - Serkan Kahraman
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul-Türkiye
| | - Gökhan Demirci
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul-Türkiye
| | - Hicaz Zencirkiran Agus
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul-Türkiye
| | - Ender Oner
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul-Türkiye
| | - Kübra Kalkan
- Department of Rheumatology, University of Health Sciences, Basaksehir Cam ve Sakura City Hospital, İstanbul-Türkiye
| | - Mustafa Yıldız
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul-Türkiye
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10
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Jain A, Subramani S, Gebhardt B, Hauser J, Bailey C, Ramakrishna H. Infective Endocarditis-Update for the Perioperative Clinician. J Cardiothorac Vasc Anesth 2023; 37:637-649. [PMID: 36725476 DOI: 10.1053/j.jvca.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
Infective endocarditis is a common pathology routinely encountered by perioperative physicians. There has been a need for a comprehensive review of this important topic. In this expert review, the authors discuss in detail the incidence, etiology, definition, microbiology, and trends of infective endocarditis. The authors discuss the clinical and imaging criteria for diagnosing infective endocarditis and the perioperative considerations for the same. Other imaging modalities to evaluate infective endocarditis also are discussed. Furthermore, the authors describe in detail the clinical risk scores that are used for determining clinical prognostic criteria and how they are tied to the current societal guidelines. Knowledge about native and prosthetic valve endocarditis, with emphasis on the timing of surgical intervention-focused surgical approaches and analysis of current outcomes, are critical to managing such patients, especially high-risk patients like those with heart failure, patients with intravenous drug abuse, and with internal pacemakers and defibrillators in situ. And lastly, with the advancement of percutaneous transcatheter valves becoming a norm for the management of various valvular pathologies, the authors discuss an in-depth review of transcatheter valve endocarditis with a focus on its incidence, the timing of surgical interventions, outcome data, and management of high-risk patients.
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Affiliation(s)
- Ankit Jain
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia & Augusta University, Augusta, GA
| | - Sudhakar Subramani
- Department of Anesthesiology and Perioperative Medicine, University of Iowa, Iowa City, IA
| | - Brian Gebhardt
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Memorial Medical Center, MA
| | - Joshua Hauser
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Caryl Bailey
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia & Augusta University, Augusta, GA
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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11
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CHARMS and PROBAST at your fingertips: a template for data extraction and risk of bias assessment in systematic reviews of predictive models. BMC Med Res Methodol 2023; 23:44. [PMID: 36800933 PMCID: PMC9936746 DOI: 10.1186/s12874-023-01849-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/24/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Systematic reviews of studies of clinical prediction models are becoming increasingly abundant in the literature. Data extraction and risk of bias assessment are critical steps in any systematic review. CHARMS and PROBAST are the standard tools used for these steps in these reviews of clinical prediction models. RESULTS We developed an Excel template for data extraction and risk of bias assessment of clinical prediction models including both recommended tools. The template makes it easier for reviewers to extract data, to assess the risk of bias and applicability, and to produce results tables and figures ready for publication. CONCLUSION We hope this template will simplify and standardize the process of conducting a systematic review of prediction models, and promote a better and more comprehensive reporting of these systematic reviews.
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12
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Rizzo V, Salmasi MY, Sabetai M, Primus C, Sandoe J, Lewis M, Woldman S, Athanasiou T. Infective endocarditis: Do we have an effective risk score model? A systematic review. Front Cardiovasc Med 2023; 10:1093363. [PMID: 36891243 PMCID: PMC9986297 DOI: 10.3389/fcvm.2023.1093363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/01/2023] [Indexed: 02/22/2023] Open
Abstract
Background Infective endocarditis (IE) is a rare, highly morbid condition with 17% in-hospital mortality. A total of 25-30% require surgery and there is ongoing debate with regard to markers predicting patient outcomes and guiding intervention. This systematic review aims to evaluate all IE risk scores currently available. Methods Standard methodology (PRISMA guideline) was used. Papers with risk score analysis for IE patients were included, with attention to studies reporting area under the receiver-operating characteristic curve (AUC/ROC). Qualitative analysis was carried out, including assessment of validation processes and comparison of these results to original derivation cohorts where available. Risk-of-bias analysis illustrated according to PROBAST guidelines. Results Of 75 articles initially identified, 32 papers were analyzed for a total of 20 proposed scores (range 66-13,000 patients), 14 of which were specific for IE. The number of variables per score ranged from 3 to 14 with only 50% including microbiological variables and 15% including biomarkers. The following scores had good performance (AUC > 0.8) in studies proposing the score (often the derivation cohort); however fared poorly when applied to a new cohort: PALSUSE, DeFeo, ANCLA, RISK-E, EndoSCORE, MELD-XI, COSTA, and SHARPEN. DeFeo score demonstrated the largest discrepancy with initial AUC of 0.88, compared to 0.58 when applied to different cohorts. The inflammatory response in IE has been well documented and CRP has been found to be an independent predictor for worse outcomes. There is ongoing investigation on alternate inflammatory biomarkers which may assist in IE management. Of the scores identified in this review, only three have included a biomarker as a predictor. Conclusion Despite the variety of available scores, their development has been limited by small sample size, retrospective collection of data and short-term outcomes, with lack of external validation, limiting their transportability. Future population studies and large comprehensive registries are required to address this unmet clinical need.
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Affiliation(s)
- Victoria Rizzo
- Cardiothoracic Surgery, St. Thomas Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mohammad Yousuf Salmasi
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael Sabetai
- Cardiothoracic Surgery, St. Thomas Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christopher Primus
- Specialised Cardiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Jonathan Sandoe
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Michael Lewis
- Department of Cardiothoracic Surgery, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Simon Woldman
- Specialised Cardiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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13
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Agrawal A, Arockiam AD, Jamil Y, El Dahdah J, Honnekeri B, Chedid El Helou M, Kassab J, Wang TKM. Contemporary risk models for infective endocarditis surgery: a narrative review. Ther Adv Cardiovasc Dis 2023; 17:17539447231193291. [PMID: 37646184 PMCID: PMC10469256 DOI: 10.1177/17539447231193291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023] Open
Abstract
Infective endocarditis is a complex heterogeneous condition involving the infection of the endocardium and heart valves, leading to severe complications, including death. Surgery is often indicated in patients with infective endocarditis but is associated with elevated risk compared with other forms of cardiac surgery. Risk models play an important role in many cardiac surgeries as they can help inform clinicians and patients regarding procedural risk, decision-making to proceed or not, and influence perioperative management; however, they remain under-utilized in the infective endocarditis settings. Another crucial role of such risk models is to assess predicted versus found mortality, thereby allowing an assessment of institutional performance in infective endocarditis surgery. Traditionally, general cardiac surgery risk models such as European System for Cardiac Operative Risk Evaluation (EuroSCORE), EuroSCORE II, and Society of Thoracic Surgeon's score have been applied to endocarditis surgery. However, there has been the development of many endocarditis surgery-specific scores over the last decade. This review aims to discuss clinical characteristics and applications of all contemporary risk scores in the setting of surgical treatment of infective endocarditis.
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Affiliation(s)
- Ankit Agrawal
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aro Daniela Arockiam
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yasser Jamil
- Yale-Waterbury, Department of Internal Medicine, Yale School of Medicine, Waterbury, CT, USA
| | - Joseph El Dahdah
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bianca Honnekeri
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michel Chedid El Helou
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Kassab
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH 44195, USA
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14
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Fernández-Cisneros A, Hernández-Meneses M, Llopis J, Sandoval E, Pereda D, Alcocer J, Barriuso C, Castellá M, Ambrosioni J, Pericàs JM, Vidal B, Falces C, Ibáñez C, Perdomo J, Rovira I, García-de-la-María C, Moreno A, Almela M, Perisinotti A, Dahl A, Castro P, Miró JM, Quintana E. Risk scores' performance and their impact on operative decision-making in left-sided endocarditis: a cohort study. Eur J Clin Microbiol Infect Dis 2023; 42:33-42. [PMID: 36346471 PMCID: PMC9816251 DOI: 10.1007/s10096-022-04516-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022]
Abstract
The accuracy of contemporary risk scores in predicting perioperative mortality in infective endocarditis (IE) remains controversial. The aim is to evaluate the performance of existent mortality risk scores for cardiovascular surgery in IE and the impact on operability at high-risk thresholds. A single-center retrospective review of adult patients diagnosed with acute left-sided IE undergoing surgery from May 2014 to August 2019 (n = 142) was done. Individualized risk calculation was obtained according to the available mortality risk scores: EuroScore I and II, PALSUSE, Risk-E, Costa, De Feo-Cotrufo, AEPEI, STS-risk, STS-IE, APORTEI, and ICE-PCS scores. A cross-validation analysis was performed on the score with the best area under the curve (AUC). The 30-day survival was 96.5% (95%CI 91-98%). The score with worse area under the curve (AUC = 0.6) was the STS-IE score, while the higher was for the RISK-E score (AUC = 0.89). The AUC of the majority of risk scores suggested acceptable performance; however, statistically significant differences in expected versus observed mortalities were common. The cross-validation analysis showed that a large number of survivors (> 75%) would not have been operated if arbitrary high-risk threshold estimates had been used to deny surgery. The observed mortality in our cohort is significantly lower than is predicted by contemporary risk scores. Despite the reasonable numeric performance of the analyzed scores, their utility in judging the operability of a given patient remains questionable, as demonstrated in the cross-validation analysis. Future guidelines may advise that denial of surgery should only follow a highly experienced Endocarditis Team evaluation.
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Affiliation(s)
- A. Fernández-Cisneros
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain
| | - M. Hernández-Meneses
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J. Llopis
- grid.5841.80000 0004 1937 0247Department of Genetics, Microbiology and Statistics, University of Barcelona, Barcelona, Spain
| | - E. Sandoval
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - D. Pereda
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - J. Alcocer
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain
| | - C. Barriuso
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain
| | - M. Castellá
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - J. Ambrosioni
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J. M. Pericàs
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain ,grid.411083.f0000 0001 0675 8654Liver Unit, Internal Medicine Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute of Research, CIBERehd, Barcelona, Spain
| | - B. Vidal
- grid.5841.80000 0004 1937 0247Cardiology Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C. Falces
- grid.5841.80000 0004 1937 0247Cardiology Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C. Ibáñez
- grid.5841.80000 0004 1937 0247Anesthesiology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J. Perdomo
- grid.5841.80000 0004 1937 0247Anesthesiology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - I. Rovira
- grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Anesthesiology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C. García-de-la-María
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A. Moreno
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M. Almela
- grid.5841.80000 0004 1937 0247Microbiology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A. Perisinotti
- grid.410458.c0000 0000 9635 9413Nuclear Medicine Department, Biomaterials and Nanomedicine (CIBER-BBN), Hospital Clinic-IDIBAPS, University of Barcelona & Biomedical Research Networking Center of Bioengineering, Barcelona, Spain
| | - A. Dahl
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - P. Castro
- grid.5841.80000 0004 1937 0247Internal Medicine Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J. M. Miró
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E. Quintana
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
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15
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Bernard S, Deferm S, Bertrand PB. Acute valvular emergencies. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:653-665. [PMID: 35912478 DOI: 10.1093/ehjacc/zuac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Acute valvular emergencies represent an important cause of cardiogenic shock. However, their clinical presentation and initial diagnostic testing are often non-specific, resulting in delayed diagnosis. Moreover, metabolic disarray or haemodynamic instability may result in too great a risk for emergent surgery. This review will focus on the aetiology, clinical presentation, diagnostic findings, and treatment options for patients presenting with native acute left-sided valvular emergencies. In addition to surgery, options for medical therapy, mechanical circulatory support, and novel percutaneous interventions are discussed.
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Affiliation(s)
- Samuel Bernard
- Department of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Sebastien Deferm
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine & Life Sciences, Hasselt University, Hasselt, Belgium
| | - Philippe B Bertrand
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine & Life Sciences, Hasselt University, Hasselt, Belgium
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16
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Surgery for Aortic Prosthetic Valve Endocarditis in the Transcatheter Era. J Clin Med 2022; 11:jcm11123418. [PMID: 35743488 PMCID: PMC9225107 DOI: 10.3390/jcm11123418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/04/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: As surgical experience with infective endocarditis following transcatheter aortic valve replacement is scarce, this study compared the perioperative and short-term outcomes of patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement. Methods: Between January 2013 and December 2020, 468 consecutive patients were admitted to our center for surgery for IE. Among them, 98 were operated on for endocarditis following surgical aortic valve replacement and 22 for endocarditis following transcatheter aortic valve replacement. Results: The median EuroSCORE II (52.1 (40.6–62.0) v/s 45.4 (32.6–58.1), p = 0.207) and STS-PROM (1.8 (1.6–2.1) v/s 1.9 (1.4–2.2), p = 0.622) were comparable. Endocarditis following transcatheter aortic valve replacement accounted for 13.7% of the aortic prosthetic valve endocarditis between 2013 and 2015; this increased to 26.9% in the years 2019 and 2020.Concomitant procedures were performed in 35 patients (29.2%). The operative mortality was 26.5% in the endocarditis following surgical aortic valve replacement group and 9.1% in the endocarditis following transcatheter aortic valve replacement group (p = 0.098). Upon follow-up, survival at 6 months was found to be 98% in the group with endocarditis following surgical aortic valve replacement and 89% in the group with endocarditis following transcatheter aortic valve replacement (p = 0.081). Conclusions: Patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement present with comparable risk profiles and can be surgically treated with comparable results. Surgery as a curative option should not be rejected even in this intermediate-risk cohort.
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17
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Luo L, Huang S, Liu C, Liu Q, Dong S, Yue Y, Liu K, Huang L, Wang S, Li H, Zheng S, Wu Z. Machine Learning-Based Risk Model for Predicting Early Mortality After Surgery for Infective Endocarditis. J Am Heart Assoc 2022; 11:e025433. [PMID: 35656984 PMCID: PMC9238722 DOI: 10.1161/jaha.122.025433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
Background The early mortality after surgery for infective endocarditis is high. Although risk models help identify patients at high risk, most current scoring systems are inaccurate or inconvenient. The objective of this study was to construct an accurate and easy-to-use prediction model to identify patients at high risk of early mortality after surgery for infective endocarditis. Methods and Results A total of 476 consecutive patients with infective endocarditis who underwent surgery at 2 centers were included. The development cohort consisted of 276 patients. Eight variables were selected from 89 potential predictors as input of the XGBoost model to train the prediction model, including platelet count, serum albumin, current heart failure, urine occult blood ≥(++), diastolic dysfunction, multiple valve involvement, tricuspid valve involvement, and vegetation >10 mm. The completed prediction model was tested in 2 separate cohorts for internal and external validation. The internal test cohort consisted of 125 patients independent of the development cohort, and the external test cohort consisted of 75 patients from another center. In the internal test cohort, the area under the curve was 0.813 (95% CI, 0.670-0.933) and in the external test cohort the area under the curve was 0.812 (95% CI, 0.606-0.956). The area under the curve was significantly higher than that of other ensemble learning models, logistic regression model, and European System for Cardiac Operative Risk Evaluation II (all, P<0.01). This model was used to develop an online, open-access calculator (http://42.240.140.58:1808/). Conclusions We constructed and validated an accurate and robust machine learning-based risk model to predict early mortality after surgery for infective endocarditis, which may help clinical decision-making and improve outcomes.
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Affiliation(s)
- Li Luo
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Sui‐qing Huang
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Chuang Liu
- School of Computer Science and TechnologyXidian UniversityXi’anP. R. China
| | - Quan Liu
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Shuohui Dong
- Department of General SurgeryQianfoshan HospitalShandong UniversityJinanP. R. China
| | - Yuan Yue
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Kai‐zheng Liu
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Lin Huang
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Shun‐jun Wang
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Hua‐yang Li
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Shaoyi Zheng
- Department of Cardiovascular SurgeryNanfang HospitalSouthern Medical UniversityGuangzhouP. R. China
| | - Zhong‐kai Wu
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
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18
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Surgical Procedure Time and Mortality in Patients with Infective Endocarditis Caused by Staphylococcus aureus or Streptococcus Species. J Clin Med 2022; 11:jcm11092538. [PMID: 35566663 PMCID: PMC9104614 DOI: 10.3390/jcm11092538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 02/05/2023] Open
Abstract
Staphylococcus aureus (SA) and Streptococcus species (SS) show different clinical manifestations in infective endocarditis (IE), but the impact on the complexity of surgical treatment remains unclear. All patients with surgically treated IE due to SA or SS between July 2013 and December 2016 were extracted from a prospectively collected, single-center registry. Data on patient characteristics, surgical procedures, and postprocedural outcomes were collected. SA-IE was more common with prosthetic valves (26.3% vs. 7.3%, p = 0.04), cardiac devices (14.3% vs. 0%, p = 0.03), previous cardiac surgery (28.6% vs. 9.8%, p = 0.03), intravenous drug abuse (14.3% vs. 0%, p = 0.03), and embolic events (57.1% vs. 26.8%, p = 0.007). Preoperative CRP was significantly higher in SA-IE (median 96.1 mg/L vs. 42.4 mg/L, p = 0.002). Otherwise, SS-IE affected more cusps/leaflets (mean 2.4 vs. 1.8, p = 0.03) and led to more valve dysfunction (83.8% vs. 54.3%, p = 0.007). Surgery times did not differ between the groups, though patients with SA spent more time in the intensive care unit (median 7 vs. 4.5 days, p = 0.04). Hospital mortality did not differ, but patients with SA-IE had unfavorable long-term survival (p = 0.001). Future studies need to be larger and focus on the mechanism behind the reduced long-term survival to mitigate the deleterious effect of SA in surgically treated patients with IE.
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19
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Abstract
The management of infective endocarditis is complex and inherently requires multidisciplinary cooperation. About half of all patients diagnosed with infective endocarditis will meet the criteria to undergo cardiac surgery, which regularly takes place in urgent or emergency settings. The pathophysiology and clinical presentation of infective endocarditis make it a unique disorder within cardiac surgery that warrants a thorough understanding of specific characteristics in the perioperative period. This includes, among others, echocardiography, coagulation, bleeding management, or treatment of organ dysfunction. In this narrative review article, the authors summarize the current knowledge on infective endocarditis relevant for the clinical anesthesiologist in perioperative management of respective patients. Furthermore, the authors advocate for the anesthesiologist to become a structural member of the endocarditis team.
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20
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Di Mauro M, Bonalumi G, Calafiore AM, Lorusso R. Valve endocarditis, to repair or not to repair, is that really the question? J Card Surg 2022; 37:1016-1018. [PMID: 35023588 DOI: 10.1111/jocs.16232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Abstract
The meta-analysis by He et al. has the worth to cover, as much as possible, a gap of scientific evidence were conducting a randomized trial appears very complex for ethical and logistical reasons. The authors concluded that mitral valve repair (MVP) provides better-pooled results, both early and late, with respect to mitral valve replacement. However, the superiority of MVP is driven by some single large cohort studies where surgeons had wide experience in the field of MVP for infective endocarditis. This finding is also confirmed by other studies. But if mitral repair produces such a better short- and long-term survival than replacement, why are there no clear indications from consensus and guidelines pushing surgeons toward the pursuit of a reconstructive procedure at almost any cost? We wonder to repair or not to repair, is that really the question? The AATS consensus suggests repairing "whenever possible" but without providing more specific indications. If the two primary goals of surgery are total removal of infected tissues and reconstruction of cardiac morphology, including repair or replacement of the affected valve(s), probably MVP should be performed in case of less extensive tissue detriment by the infection. In more wide valve involvement, MVP may be the choice but only in very expert hands and in Centers with a very large volumes of valve repairing. This decision cannot, therefore, be the result of the choice of an individual but must derive from a careful multidisciplinary discussion to be held in an EndoTeam.
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Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Giorgia Bonalumi
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | | | - Roberto Lorusso
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
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21
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Wang A, Fosbøl EL. Current recommendations and uncertainties for surgical treatment of infective endocarditis: a comparison of American and European cardiovascular guidelines. Eur Heart J 2022; 43:1617-1625. [PMID: 35029274 DOI: 10.1093/eurheartj/ehab898] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/11/2021] [Accepted: 12/21/2021] [Indexed: 12/13/2022] Open
Abstract
Surgery is an effective therapy in the treatment of left-sided infective endocarditis (IE) in patients for whom antibiotic treatment alone is unlikely to be curative or may be associated with ongoing risk of complications. However, the interplay between indication for surgery, its risk, and timing is complex and there continue to be challenges in defining the effects of surgery on disease-related outcome. Guidelines published by the American College of Cardiology/American Heart Association and the European Society of Cardiology provide recommendations for the use of surgery in IE, but these are limited by a low level of evidence related to predominantly observational studies with inherent selection and survival biases. Evidence to guide the timing of surgery in IE is less robust, and predominantly based on expert consensus. Delays between IE diagnosis and recognition of an IE complication as a surgical indication and transfers to surgical centres also impact surgical timing. This comparison of the two guidelines exposes areas of uncertainty and gaps in current evidence for the use of surgery in IE across different indications, particularly related to its timing and consideration of operative risk.
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Affiliation(s)
- Andrew Wang
- Duke University Hospital, DUMC 3428, Durham, NC 27710, USA
| | - Emil L Fosbøl
- University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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22
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Fernandez-Felix BM, Barca LV, Garcia-Esquinas E, Correa-Pérez A, Fernández-Hidalgo N, Muriel A, Lopez-Alcalde J, Álvarez-Diaz N, Pijoan JI, Ribera A, Elorza EN, Muñoz P, Fariñas MDC, Goenaga MÁ, Zamora J. Prognostic models for mortality after cardiac surgery in patients with infective endocarditis: a systematic review and aggregation of prediction models. Clin Microbiol Infect 2021; 27:1422-1430. [PMID: 34620380 DOI: 10.1016/j.cmi.2021.05.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/19/2021] [Accepted: 05/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are several prognostic models to estimate the risk of mortality after surgery for active infective endocarditis (IE). However, these models incorporate different predictors and their performance is uncertain. OBJECTIVE We systematically reviewed and critically appraised all available prediction models of postoperative mortality in patients undergoing surgery for IE, and aggregated them into a meta-model. DATA SOURCES We searched Medline and EMBASE databases from inception to June 2020. STUDY ELIGIBILITY CRITERIA We included studies that developed or updated a prognostic model of postoperative mortality in patient with IE. METHODS We assessed the risk of bias of the models using PROBAST (Prediction model Risk Of Bias ASsessment Tool) and we aggregated them into an aggregate meta-model based on stacked regressions and optimized it for a nationwide registry of IE patients. The meta-model performance was assessed using bootstrap validation methods and adjusted for optimism. RESULTS We identified 11 prognostic models for postoperative mortality. Eight models had a high risk of bias. The meta-model included weighted predictors from the remaining three models (EndoSCORE, specific ES-I and specific ES-II), which were not rated as high risk of bias and provided full model equations. Additionally, two variables (age and infectious agent) that had been modelled differently across studies, were estimated based on the nationwide registry. The performance of the meta-model was better than the original three models, with the corresponding performance measures: C-statistics 0.79 (95% CI 0.76-0.82), calibration slope 0.98 (95% CI 0.86-1.13) and calibration-in-the-large -0.05 (95% CI -0.20 to 0.11). CONCLUSIONS The meta-model outperformed published models and showed a robust predictive capacity for predicting the individualized risk of postoperative mortality in patients with IE. PROTOCOL REGISTRATION PROSPERO (registration number CRD42020192602).
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Affiliation(s)
- Borja M Fernandez-Felix
- Clinical Biostatistics Unit, Hospital Universitario Ramon y Cajal (IRYCIS), Madrid, Spain; CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Laura Varela Barca
- Department of Cardiovascular Surgery, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - Esther Garcia-Esquinas
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; IdiPaz (Hospital Universitario La Paz-Universidad Autónoma de Madrid), Madrid, Spain
| | - Andrea Correa-Pérez
- Clinical Biostatistics Unit, Hospital Universitario Ramon y Cajal (IRYCIS), Madrid, Spain; Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Nuria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Alfonso Muriel
- Clinical Biostatistics Unit, Hospital Universitario Ramon y Cajal (IRYCIS), Madrid, Spain; CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jesus Lopez-Alcalde
- Clinical Biostatistics Unit, Hospital Universitario Ramon y Cajal (IRYCIS), Madrid, Spain; CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain; Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain; Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Noelia Álvarez-Diaz
- Medical Library, Hospital Universitario Ramon y Cajal (IRYCIS), Madrid, Madrid, Spain
| | - Jose I Pijoan
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain; Hospital Universitario Cruces/OSI EEC, Barakaldo, Spain; Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
| | - Aida Ribera
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain; Cardiovascular Epidemiology and Research Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Enrique Navas Elorza
- Department of Infectology, Hospital Universitario Ramon y Cajal (IRYCIS), Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - María Del Carmen Fariñas
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Miguel Ángel Goenaga
- Infectious Diseases Service, Hospital Universitario Donostia, IIS Biodonostia, OSI Donostialdea, San Sebastián, Spain
| | - Javier Zamora
- Clinical Biostatistics Unit, Hospital Universitario Ramon y Cajal (IRYCIS), Madrid, Spain; CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain; WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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23
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Garcia Granja PE, Lopez J, Vilacosta I, Saéz C, Cabezón G, Olmos C, Jerónimo A, Pérez JB, De Stefano S, Maroto L, Carnero M, Monguio E, Pulido P, de Miguel M, Gomez Salvador I, Carrasco-Moraleja M, San Román JA. Prognostic impact of cardiac surgery in left-sided infective endocarditis according to risk profile. Heart 2021; 107:1987-1994. [PMID: 34509995 DOI: 10.1136/heartjnl-2021-319661] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/22/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate the prognostic impact of urgent cardiac surgery on the prognosis of left-sided infective endocarditis (LSIE) and its relationship to the basal risk of the patient and to the surgical indication. METHODS 605 patients with LSIE and formal surgical indication were consecutively recruited between 2000 and 2020 among three tertiary centres: 405 underwent surgery during the active phase of the disease and 200 did not despite having indication. The prognostic impact of urgent surgery was evaluated by multivariable analysis and propensity score analysis. We studied the benefit of surgery according to baseline mortality risk defined by the ENDOVAL score and according to surgical indication. RESULTS Surgery is an independent predictor of survival in LSIE with surgical indication both by multivariable analysis (OR 0.260, 95% CI 0.162 to 0.416) and propensity score (mortality 40% vs 66%, p<0.001). Its greatest prognostic benefit is seen in patients at highest risk (predicted mortality 80%-100%: OR 0.08, 95% CI 0.021 to 0.299). The benefit of surgery is especially remarkable for uncontrolled infection indication (OR 0.385, 95% CI 0.194 to 0.765), even in combination with heart failure (OR 0.220, 95% CI 0.077 to 0.632). CONCLUSIONS Surgery during active LSIE seems to significantly reduce in-hospital mortality. The higher the risk, the higher the improvement in outcome.
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Affiliation(s)
- Pablo Elpidio Garcia Granja
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain .,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Javier Lopez
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Isidre Vilacosta
- Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Carmen Saéz
- Internal Medicine Department, Instituto de investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Madrid, Spain
| | - Gonzalo Cabezón
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Carmen Olmos
- Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Adrián Jerónimo
- Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Javier B Pérez
- Internal Medicine Department, Instituto de investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Madrid, Spain
| | - Salvatore De Stefano
- Department of Cardiac Surgery. Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Luis Maroto
- Department of Cardiac Surgery, Instituto Cardiovascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Carnero
- Department of Cardiac Surgery, Instituto Cardiovascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Emilio Monguio
- Department of Cardiac Surgery, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Hospital Universitario La Princesa, Madrid, Spain
| | - Paloma Pulido
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - María de Miguel
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Itziar Gomez Salvador
- Biostatistics Department, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Manuel Carrasco-Moraleja
- Biostatistics Department, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - J Alberto San Román
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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24
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Varela Barca L, Fernández-Felix BM, Navas Elorza E, Mestres CA, Muñoz P, Cuerpo-Caballero G, Rodríguez-Abella H, Montejo-Baranda M, Rodríguez-Álvarez R, Gutiérrez Díez F, Goenaga MA, Quintana E, Ojeda-Burgos G, de Alarcón A, Vidal-Bonet L, Centella Hernández T, López-Menéndez J. Prognostic assessment of valvular surgery in active infective endocarditis: multicentric nationwide validation of a new score developed from a meta-analysis. Eur J Cardiothorac Surg 2021; 57:724-731. [PMID: 31782783 DOI: 10.1093/ejcts/ezz328] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Several risk prediction models have been developed to estimate the risk of mortality after valve surgery for active infective endocarditis (IE), but few external validations have been conducted to assess their accuracy. We previously developed a systematic review and meta-analysis of the impact of IE-specific factors for the in-hospital mortality rate after IE valve surgery, whose obtained pooled estimations were the basis for the development of a new score (APORTEI). The aim of the present study was to assess its prognostic accuracy in a nationwide cohort. METHODS We analysed the prognostic utility of the APORTEI score using patient-level data from a multicentric national cohort. Patients who underwent surgery for active IE between 2008 and 2018 were included. Discrimination was evaluated using the area under the receiver operating characteristic curve, and the calibration was assessed using the calibration slope and the Hosmer-Lemeshow test. Agreement between the APORTEI and the EuroSCORE I was also analysed by Lin's concordance correlation coefficient (CCC), the Bland-Altman agreement analysis and a scatterplot graph. RESULTS The 11 variables that comprised the APORTEI score were analysed in the sample. The APORTEI score was calculated in 1338 patients. The overall observed surgical mortality rate was 25.56%. The score demonstrated adequate discrimination (area under the receiver operating characteristic curve = 0.75; 95% confidence interval 0.72-0.77) and calibration (calibration slope = 1.03; Hosmer-Lemeshow test P = 0.389). We found a lack of agreement between the APORTEI and EuroSCORE I (concordance correlation coefficient = 0.55). CONCLUSIONS The APORTEI score, developed from a systematic review and meta-analysis, showed an adequate estimation of the risk of mortality after IE valve surgery in a nationwide cohort.
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Affiliation(s)
- Laura Varela Barca
- Department of Cardiovascular Surgery, University Hospital Son Espases, Palma de Mallorca, Spain.,University of Alcalá de Henares, Madrid, Spain
| | - Borja M Fernández-Felix
- University of Alcalá de Henares, Madrid, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS), Madrid, Spain
| | | | - Carlos A Mestres
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Patricia Muñoz
- CIBER Enfermedades Respiratorias-CIBERES, Instituto de Salud Carlos III, Madrid, Spain.,Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón-Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Hugo Rodríguez-Abella
- Department of Cardiovascular Surgery, University Hospital Gregorio Marañón, Madrid, Spain
| | | | - Regino Rodríguez-Álvarez
- Department of Cardiovascular Surgery, University Hospital Marques de Valdecilla, Santander, Spain
| | | | | | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville, CSIC, University Hospital Virgen del Rocío, Seville, Spain
| | - Laura Vidal-Bonet
- Department of Cardiovascular Surgery, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Tomasa Centella Hernández
- University of Alcalá de Henares, Madrid, Spain.,Department of Cardiovascular Surgery, University Hospital Ramon y Cajal, Madrid, Spain
| | - Jose López-Menéndez
- University of Alcalá de Henares, Madrid, Spain.,Department of Cardiovascular Surgery, University Hospital Ramon y Cajal, Madrid, Spain
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25
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Benedetto U, Avtaar Singh SS, Spadaccio C, Moon MR, Nappi F. A narrative review of the interpretation of guidelines for the treatment of infective endocarditis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1623. [PMID: 33437822 PMCID: PMC7791230 DOI: 10.21037/atm-20-3739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The recommendations of the current guidelines and the position papers of professional societies from the European Society of Cardiology/European Society of Cardiothoracic Surgeons (ESC), the American College of Cardiology/American Heart Association/Society of Thoracic Surgeon (ACC/AHA/STS) and American Association of Thoracic Surgeon (AATS) regarding management of patients with valvular heart endocarditis were updated over the past decade. However, some of the recommendations appear to contradict one another. Given the changing paradigms on how the disease manifests, our aim was to review the respective guidelines and highlight these differences whilst drawing attention to the subsequent studies from which they were derived. In particular, concerns regarding antibiotic prophylaxis and therapy, imaging modality for diagnosis and follow-up, cerebrovascular sequalae and timing of surgery are appraised in detail. We also identified the novel techniques used such as transcatheter therapies and advances in imaging modalities used for diagnosis and treatment of this condition. The lack of randomised control trials (RCTs) does raise several issues regarding applicability of findings in day-to-day practice. Therefore, the focus of upcoming studies should be on clearly defined multicenter RCTs to provide more robust evidence for the management and treatment of infective endocarditis as future guidelines will be based on the outcomes of these trials.
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Affiliation(s)
- Umberto Benedetto
- Department of Cardiothoracic Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Sanjeet Singh Avtaar Singh
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Marc R Moon
- Department of Cardiac Thoracic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
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26
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Nappi F, Spadaccio C, Moon MR. A management framework for left sided endocarditis: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1627. [PMID: 33437826 PMCID: PMC7791223 DOI: 10.21037/atm-20-4439] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Left sided endocarditis (LSE) can include the entirety or portion of mitral and/or aortic valve and the structures in their anatomical contiguity and represent a significant portion of emergency surgical activity. Literature and guidelines on the management of LSE relies mainly on observational studies given the difficulty in designing randomized trials in emergency settings. Heart teams (HT) are often called in to difficult decisions on the most appropriate strategy to adopted in case of LSE. Decision-making should take into account the localization and the extension of the infection, patient preoperative status and comorbidities, presence of a previous valve prosthesis and best timing for surgery. Despite evidence suggests that early surgery may improve survival in patients with complicated infective endocarditis (IE), an increased risk of recurrence and postoperative valvular dysfunctions has been reported. The most important factors associated with long-term outcomes are preoperative multiorgan failure, prosthetic mechanical valve IE, vegetation size ≥15 mm, and timing of surgical treatment. Importantly, up to one third of potential candidates do not undergo surgery and these patients experience extremely high mortality rates. Another important point regards the choice of the optimal valve substitute to be used according to the different clinical situation. The lack of RCT in this field and the difficulty to design this type of studies in the case of non-elective conditions further complicates the possibility to achieve a univocal consensus on the best strategy to be adopted in each form of LSE and further validation studies are needed. On the basis of the current evidences a decisional algorithm is proposed summarizing all the crucial aspects in the management of LSE.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Marc R Moon
- Department of Cardiac Thoracic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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27
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Nappi F, Spadaccio C, Mihos C. Infective endocarditis in the 21st century. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1620. [PMID: 33437819 PMCID: PMC7791244 DOI: 10.21037/atm-20-4867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Cristiano Spadaccio
- Department of Cardiac Surgery. Golden Jubilee National Hospital, Glasgow, UK.,Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Christos Mihos
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
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Diab D, Haziza F, Russel S, de Lentdecker P, Lanzac E, Debauchez M, Benamer H. [Surgical treatment of infective endocarditis: Surgical indications, complications, intrahospital and long-term mortality]. Ann Cardiol Angeiol (Paris) 2020; 69:385-391. [PMID: 33067007 DOI: 10.1016/j.ancard.2020.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/23/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND In addition to medical treatment, half of the patients with infective endocarditis (IE) receive surgical treatment. Despite clear recommendations on the indications and the operating delays, the decision remains difficult and must take into consideration several factors. METHODS A retrospective study was performed at Foch Hospital. All patients operated for IE between 2005 and 2018 were included. Patient characteristics, indications and operating delays, as well as intrahospital mortality, were noted. Patient follow-up was provided by phone calls. RESULTS Fifty-two patients were operated on for IE between 2005 and 2018. The most frequent surgical indications were the presence of a massive symptomatic regurgitation, an uncontrolled infection and large vegetations with embolism. The average operative delay was 13.2 days with 56.5% of patients operated within the first 10 days. The most common postoperative complications were acute kidney injury (AKI) in 57.7% of cases, with 9.6% of dialysis, shock in 50% of cases, rhythm disorders in 40.4% of cases, infectious complications in 19.2% of cases, conductive disorders in 25% of cases, of which 17.3% require a definitive pacemaker implementation. The intrahospital mortality was 7.7% and the average length of hospital stay was 35 days. Survival at one year and 5 years was 95% and 85%, respectively. CONCLUSION The indications and the operating delays were conformed to international recommendations. Intrahospital and long-term mortality rate was low.
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Affiliation(s)
- D Diab
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - F Haziza
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - S Russel
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - P de Lentdecker
- Institut mutualiste Monsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - E Lanzac
- Institut mutualiste Monsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - M Debauchez
- Institut mutualiste Monsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - H Benamer
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Institut Jacques Cartier, ICPS Ramsay Générale de santé, 6, avenue du noyer Lambert, 91300 Massy, France; Collège de médecine des hôpitaux de Paris, Paris, France
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Tousoulis D. Infective endocarditis: Time for new diagnostic criteria and management strategies? Hellenic J Cardiol 2020; 61:231-232. [PMID: 33039575 DOI: 10.1016/j.hjc.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Dimitris Tousoulis
- 1(st) Cardiology Department, National and Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece.
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Wang TKM, Bin Saeedan M, Chan N, Obuchowski NA, Shrestha N, Xu B, Unai S, Cremer P, Grimm RA, Griffin BP, Flamm SD, Pettersson GB, Popovic ZB, Bolen MA. Complementary Diagnostic and Prognostic Contributions of Cardiac Computed Tomography for Infective Endocarditis Surgery. Circ Cardiovasc Imaging 2020; 13:e011126. [PMID: 32900226 DOI: 10.1161/circimaging.120.011126] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cardiac computed tomography (CT) is emerging as an adjunctive modality to echocardiography in the evaluation of infective endocarditis (IE) and surgical planning. CT studies in IE have, however, focused on its diagnostic rather than prognostic utility, the latter of which is important in high-risk diseases like IE. We evaluated the associations between cardiac CT and transesophageal echocardiography (TEE) findings and adverse outcomes after IE surgery. METHODS Of 833 consecutive patients with surgically proven IE during May 1, 2014 to May 1, 2019, at Cleveland Clinic, 155 underwent both preoperative ECG-gated contrast-enhanced CT and TEE. Multivariable analyses were performed to identify CT and TEE biomarkers that predict adverse outcomes after IE surgery, adjusting for EuroSCORE II (European System for Cardiac operative Risk Evaluation II). RESULTS CT and TEE were positive for IE in 123 (75.0%) and 124 (75.6%) of patients, respectively. Thirty-day mortality occurred in 3 (1.9%) patients and composite mortality or morbidities in 72 (46.5%). Pseudoaneurysm or abscess detected on TEE was the only imaging biomarker to show independent association with composite mortality or morbidities in-hospital, with odds ratio (95% CI) of 3.66 (1.76-7.59), P=0.001. There were 17 late deaths, and both pseudoaneurysm or abscess detected on CT and fistula detected on CT were the only independent predictors of total mortality during follow-up, with hazards ratios (95% CI) of 3.82 (1.25-11.7), P<0.001 and 9.84 (1.89-51.0), P=0.007, respectively. CONCLUSIONS We identified cardiac CT and TEE features that predicted separate adverse outcomes after IE surgery. Imaging biomarkers can play important roles incremental to conventional clinical factors for risk stratification in patients undergoing IE surgery.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (T.K.M.W., N.C., B.X., P.C., R.A.G., B.P.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH.,Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., M.B.S., N.A.O., B.X., P.C., R.A.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH
| | - Mnahi Bin Saeedan
- Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., M.B.S., N.A.O., B.X., P.C., R.A.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH
| | - Nicholas Chan
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (T.K.M.W., N.C., B.X., P.C., R.A.G., B.P.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH
| | - Nancy A Obuchowski
- Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., M.B.S., N.A.O., B.X., P.C., R.A.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH.,Department of Quantitative Health Sciences (N.A.O.), Cleveland Clinic, OH
| | - Nabin Shrestha
- Department of Infectious Disease, Respiratory Institute (N.S.), Cleveland Clinic, OH
| | - Bo Xu
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (T.K.M.W., N.C., B.X., P.C., R.A.G., B.P.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH.,Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., M.B.S., N.A.O., B.X., P.C., R.A.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute (S.U, G.B.P.), Cleveland Clinic, OH
| | - Paul Cremer
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (T.K.M.W., N.C., B.X., P.C., R.A.G., B.P.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH.,Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., M.B.S., N.A.O., B.X., P.C., R.A.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH
| | - Richard A Grimm
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (T.K.M.W., N.C., B.X., P.C., R.A.G., B.P.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH.,Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., M.B.S., N.A.O., B.X., P.C., R.A.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (T.K.M.W., N.C., B.X., P.C., R.A.G., B.P.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH
| | - Scott D Flamm
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (T.K.M.W., N.C., B.X., P.C., R.A.G., B.P.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute (S.U, G.B.P.), Cleveland Clinic, OH
| | - Zoran B Popovic
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (T.K.M.W., N.C., B.X., P.C., R.A.G., B.P.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH.,Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., M.B.S., N.A.O., B.X., P.C., R.A.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH
| | - Michael A Bolen
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (T.K.M.W., N.C., B.X., P.C., R.A.G., B.P.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH.,Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., M.B.S., N.A.O., B.X., P.C., R.A.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH
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Carino D, Fernández-Cisneros A, Hernández-Meneses M, Sandoval E, Llopis J, Falces C, Miró JM, Quintana E. The fate of active left-side infective endocarditis with operative indication in absence of valve surgery. J Card Surg 2020; 35:3034-3040. [PMID: 32827161 DOI: 10.1111/jocs.14967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Although the benefits of surgery in infective endocarditis (IE) are clear, an unneglectable proportion of patients do not undergo surgery despite clear operative indication. Outcomes of these patients are poorly reported. With this study, we aim to analyze patient profiles, indication for surgery, decision-making, and outcomes of patients not undergoing surgery despite contemporary surgical indications. MATERIALS AND METHODS Retrospective review of single institution database of patients with IE was done to identify patients that, although a clear surgical indication did not receive surgery. We aimed to review the most contemporary practice from June 2014 to December 2018. Only patients who were physically evaluated at our facility were included. Follow up was 100% complete. Kaplan-Meier methods were used to estimate survival and freedom from a composite outcome of death, stroke, and heart failure. RESULTS Of the 174 patients with surgical indication during the review period, 46 (27%) did not undergo surgery. The reasons for not pursuing surgery were varied and usually multiple, with severe brain injury and end stage liver disease between the most common. The 30-day mortality was 63%, and the estimated survival at 6 months, 1 year, and 2 years was respectively 22%, 15%, and 10%. CONCLUSION The mortality of this cohort of patients is extremely high. A multidisciplinary evaluation is of paramount importance in the decision-making process with shared responsibility for denial of operative options. In a perspective of correct healthcare resources allocation an early palliative care consult may need to be considered in some of those patients.
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Affiliation(s)
- Davide Carino
- Department of Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Alejandro Fernández-Cisneros
- Department of Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Marta Hernández-Meneses
- Department of Infectious Disease, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Elena Sandoval
- Department of Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Jaume Llopis
- Department of Genetic, Microbiology and Statistics, University of Barcelona, Barcelona, Spain
| | - Carlos Falces
- Department of Cardiology, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain
| | - José M Miró
- Department of Infectious Disease, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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Gatti G, Chocron S, Obadia JF, Duval X, Iung B, Alla F, Chirouze C, Lecompte T, Hoen B, Delahaye F, Tattevin P, Le Moing V, Perrotti A. Using surgical risk scores in nonsurgically treated infective endocarditis patients. Hellenic J Cardiol 2020; 61:246-252. [DOI: 10.1016/j.hjc.2019.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/03/2019] [Accepted: 01/11/2019] [Indexed: 11/25/2022] Open
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Harky A, Zaim S, Mallya A, George JJ. Optimizing outcomes in infective endocarditis: A comprehensive literature review. J Card Surg 2020; 35:1600-1608. [PMID: 32598562 DOI: 10.1111/jocs.14656] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite being rare, infective endocarditis (IE) is a life-threatening disease with poor prognosis. New diagnostic and therapeutic strategies are emerging; however, predisposing factors and microbiology of the disease are also changing with time. Because of this, there has been a lack of reduction in the disease's incidence and new challenges for clinicians have arisen such as an increasingly aging population and growing antimicrobial resistance. AIMS In this paper, we aim to provide an overview of the changing trends in IE, current diagnosis, and management strategies, as well as the emerging role of the infective endocarditis teams in the care of patients with this disease. MATERIALS & METHODS A comprehensive electronic search was done utilizing PubMed, Ovid, SCOPUS, Embase and google scholar. The search terms included 'Endocarditis', 'IE', 'Infection', 'Vegetation', 'Duke criteria', 'native valve infection', 'prosthetic valve', 'valve infection', 'endocarditis outcome' and 'endocarditis bacteriology'. The references of the identified articles were then searched for any potential articles that can be included. The inclusion criteria were any article that discussed the evidence behind incidence and management of IE including the role of endocarditis team. The exclusion criteria were case reports, expert opinion, and editorials. RESULTS All the relevant findings are summarized in specified tables and within appropriate sections. DISCUSSION It is vital to determine the current trends in the epidemiology and microbiology of the condition so that the diagnostic threshold can be adapted, to identify new at-risk groups and achieve an accelerated evaluation strategy that allows for earlier diagnosis and treatment. CONCLUSION Management of IE can benefit from the input of different specialties, such as cardiology, cardiothoracic surgery, infectious disease, and microbiology. Therefore, adopting a multidisciplinary approach towards treatment is crucial to reduce morbidity and mortality from preventable complications of this pathology.
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Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Medicine, School of Medicine, University of Liverpool, Liverpool, UK
| | - Sevim Zaim
- Department of Medicine, School of Medicine, University of Liverpool, Liverpool, UK
| | - Apeksha Mallya
- Department of Medicine, School of Medicine, University of Liverpool, Liverpool, UK
| | - Joel Jacob George
- Department of Medicine, School of Medicine, University of Liverpool, Liverpool, UK
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34
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Salsano A, Giacobbe DR, Del Puente F, Natali R, Miette A, Moscatelli S, Perocchio G, Scarano F, Porto I, Mariscalco G, Bassetti M, Santini F. Culture-negative infective endocarditis (CNIE): impact on postoperative mortality. Open Med (Wars) 2020; 15:571-579. [PMID: 33336013 PMCID: PMC7712125 DOI: 10.1515/med-2020-0193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/30/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Poor postoperative outcomes have been reported after surgery for infective endocarditis (IE). Whether the absence of positive cultures impacts the prognosis remains a matter of discussion. The aim of this study was to evaluate the impact of negative cultures on the prognosis of surgically treated IE. Methods This was a single-center, retrospective study. From January 2000 to June 2019, all patients who underwent valvular surgery for IE were included in the study. The primary endpoint was early postoperative mortality. A covariate balancing propensity score was developed to minimize the differences between the culture-positive IE (CPIE) and culture-negative IE (CNIE) cohorts. Using the estimated propensity scores as weights, an inverse probability treatment weighting (IPTW) model was built to generate a weighted cohort. Then, to adjust for confounding related to CPIE and CNIE, a doubly robust method that combines regression model with IPTW by propensity score was adopted to estimate the causal effect of the exposure on the outcome. Results During the study period, 327 consecutive patients underwent valvular repair/replacement with the use of cardiopulmonary bypass and cardioplegic cardiac arrest for IE. Their mean age was 61.4 ± 15.4 years, and 246 were males (75.2%). Native valve IE and prosthetic valve IE accounted for 87.5% and 12.5% of cases, respectively. Aortic (182/327, 55.7%) and mitral valves (166/327, 50.8%) were mostly involved; 20.5% of isolated mitral valve diseases were repaired (22/107 patients). The tricuspid valve was involved in 10 patients (3.3%), and the pulmonary valve in 1 patient (<1%). Fifty-nine patients had multiple-valve disease (18.0%). Blood cultures were negative in 136/327 (41.6 %). A higher postoperative mortality was registered in CNIE than in CPIE patients (19% vs 9%, respectively, p = 0.01). The doubly robust analysis after IPTW by propensity score showed CNIE to be associated with early postoperative mortality (odds ratio 2.10; 95% CI, 1.04–4.26, p = 0.04). Conclusions In our cohort, CNIE was associated with a higher early postoperative mortality in surgically treated IE patients after dedicated adjustment for confounding. In this perspective, any effort to improve preoperative microbiological diagnosis, thus allowing targeted therapeutic initiatives, might lead to overall better postoperative outcomes in surgically treated IE.
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Affiliation(s)
- Antonio Salsano
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
| | - Daniele Roberto Giacobbe
- Clinica Malattie Infettive, Ospedale Policlinico San Martino – IRCCS, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Filippo Del Puente
- Clinica Malattie Infettive, Ospedale Policlinico San Martino – IRCCS, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Roberto Natali
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
| | - Ambra Miette
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
| | - Sara Moscatelli
- Division of Cardiology, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Internal Medicine (DIMI), University of Genoa, Genova, Italy
| | - Giacomo Perocchio
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
| | - Flavio Scarano
- Division of Cardiology, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Internal Medicine (DIMI), University of Genoa, Genova, Italy
| | - Italo Porto
- Division of Cardiology, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Internal Medicine (DIMI), University of Genoa, Genova, Italy
| | - Giovanni Mariscalco
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - Matteo Bassetti
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Francesco Santini
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
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Varela L, Vidal L, Fernández-Felix BM, Ventosa G, Navas E, Hidalgo I, Rodríguez-Roda J, Sáez de Ibarra JI, López-Menéndez J. Estimación de la mortalidad quirúrgica de la endocarditis infecciosa: comparación de las diferentes escalas específicas de cálculo de riesgo. CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Martins ABB, Lamas CDC. Prognostic Scores for Mortality in Cardiac Surgery for Infective Endocarditis. Arq Bras Cardiol 2020; 114:525-529. [PMID: 32267325 PMCID: PMC7792738 DOI: 10.36660/abc.20200070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Alexandre Bahia Barreiras Martins
- Unidade CardiointensivaClínica São Vicente da GáveaRio de JaneiroRJBrasilUnidade Cardiointensiva - Clínica São Vicente da Gávea, Rio de Janeiro, RJ - Brasil
| | - Cristiane da Cruz Lamas
- Coordenação de Ensino e PesquisaInstituto Nacional de CardiologiaRio de JaneiroRJBrasilCoordenação de Ensino e Pesquisa - Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil
- Escola de Ciências da SaúdeUniversidade do Grande RioRio de JaneiroRJBrasilEscola de Ciências da Saúde - Universidade do Grande Rio (Unigranrio), Rio de Janeiro, RJ - Brasil
- Centro HospitalarInstituto Nacional de Infectologia Evandro ChagasFiocruzRio de JaneiroRJBrasilCentro Hospitalar - Instituto Nacional de Infectologia Evandro Chagas - Fiocruz, Rio de Janeiro, RJ – Brasil
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Abstract
The annual incidence of infective endocarditis (IE) is estimated to be between 15 and 80 cases per million persons in population-based studies. The incidence of IE is markedly increased in patients with valve prostheses (>4 per 1,000) or with prior IE (>10 per 1,000). The interaction between platelets, microorganisms and diseased valvular endothelium is the cause of vegetations and valvular or perivalvular tissue destruction. Owing to its complexity, the diagnosis of IE is facilitated by the use of the standardized Duke-Li classification, which combines two major criteria (microbiology and imaging) with five minor criteria. However, the sensitivity of the Duke-Li classification is suboptimal, particularly in prosthetic IE, and can be improved by the use of PET or radiolabelled leukocyte scintigraphy. Prolonged antibiotic therapy is mandatory. Indications for surgery during acute IE depend on the presence of haemodynamic, septic and embolic complications. The most urgent indications for surgery are related to heart failure. In the past decade, the prevention of IE has been reoriented, with indications for antibiotic prophylaxis now limited to patients at high risk of IE undergoing dental procedures. Guidelines now emphasize the importance of nonspecific oral and cutaneous hygiene in individual patients and during health-care procedures.
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Balla S, Alkhouli M. Infective endocarditis and outcomes of valve surgery: the bug, the valve, the host and the unknown. J Thorac Dis 2019; 11:E178-E181. [PMID: 31737333 DOI: 10.21037/jtd.2019.09.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sudarshan Balla
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, USA
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Tattevin P, Fillâtre P, Tchamgoué S, Lesouhaitier M, Nesseler N, Tadié JM. Should we include microorganisms in scores to predict outcome in candidates for cardiac surgery during the acute phase of endocarditis? J Thorac Dis 2019; 11:E158-E162. [PMID: 31737328 DOI: 10.21037/jtd.2019.09.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Pierre Fillâtre
- Intensive Care Unit, Yves Le Foll Hospital, Saint Brieuc, France
| | - Serge Tchamgoué
- Internal Medicine and Infectious Diseases, Robert Boulin Hospital, Libourne, France
| | - Mathieu Lesouhaitier
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Nicolas Nesseler
- Cardiovascular Thoracic Surgery Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Jean-Marc Tadié
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
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40
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Pericàs JM, Quintana E, Miró JM. Bugs at the operating theatre in infective endocarditis: one step forward, still a long way to go. J Thorac Dis 2019; 11:E182-E191. [PMID: 31737334 DOI: 10.21037/jtd.2019.09.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Juan M Pericàs
- Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.,Clinical Direction of Infectious Diseases and Microbiology, Hospital Universitari Arnau de Vilanova-Hospital Universitari Santa Maria, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Eduard Quintana
- Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.,Cardiovascular Surgery Department, Hospital Clínic, Barcelona, Spain
| | - José M Miró
- Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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Kumar A, Anstey C, Tesar P, Shekar K. Risk Factors for Mortality in Patients Undergoing Cardiothoracic Surgery for Infective Endocarditis. Ann Thorac Surg 2019; 108:1101-1106. [PMID: 31276645 DOI: 10.1016/j.athoracsur.2019.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 04/20/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study aimed to identify risk factors associated with mortality of patients who undergo cardiac surgery for infective endocarditis. METHODS A retrospective review was performed of patients with infective endocarditis who underwent cardiac surgery at a quaternary Australian hospital between 2004 and 2014. Patient data were collected and prospectively analyzed. RESULTS In all, 465 patients underwent surgery during the study period, with 30 deaths (6.45%). Factors independently associated with in-hospital mortality were increasing age (odds ratio [OR] 1.04; 95% confidence interval [CI], 1.01 to 1.07; P = .009), active bacterial endocarditis at time of operation (OR 4.91; 95% CI, 1.01 to 23.8; P = .048), preoperative invasive positive pressure ventilation (OR 3.65; 95% CI, 1.18 to 11.27; P = .025), increasing cardiopulmonary bypass time (OR 1.01; 95% CI, 1.006 to 1.014; P < .001), and increasing European System for Cardiac Operative Risk Evaluation score (OR 21.73; 95% CI, 2.12 to 223.11; P < .01). CONCLUSIONS The in-hospital mortality of patients with infective endocarditis remains significant, with potential risk factors including increasing age, active bacterial endocarditis, preoperative invasive positive pressure ventilation, increasing cardiopulmonary bypass time, and high European System for Cardiac Operative Risk Evaluation score.
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Affiliation(s)
- Aashish Kumar
- Department of Intensive Care, Mater Hospital, Brisbane, Queensland, Australia.
| | - Chris Anstey
- Department of Intensive Care, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Peter Tesar
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Kiran Shekar
- Department of Intensive Care, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Prognostic factors of mortality after surgery in infective endocarditis: systematic review and meta-analysis. Infection 2019; 47:879-895. [PMID: 31254171 DOI: 10.1007/s15010-019-01338-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/22/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE There is a lack of consensus about which endocarditis-specific preoperative characteristics have an actual impact over postoperative mortality. Our objective was the identification and quantification of these factors. METHODS We performed a systematic review of all the studies which reported factors related to in-hospital mortality after surgery for acute infective endocarditis, conducted according to PRISMA recommendations. A search string was constructed and applied on three different databases. Two investigators independently reviewed the retrieved references. Quality assessment was performed for identification of potential biases. All the variables that were included in at least two validated risk scores were meta-analyzed independently, and the pooled estimates were expressed as odds ratios (OR) with their confidence intervals (CI). RESULTS The final sample consisted on 16 studies, comprising a total of 7484 patients. The overall pooled OR were statistically significant (p < 0.05) for: age (OR 1.03, 95% CI 1.00-1.05), female sex (OR 1.56, 95% CI 1.35-1.81), urgent or emergency surgery (OR 2.39 95% CI 1.91-3.00), previous cardiac surgery (OR 2.19, 95% CI 1.84-2.61), NYHA ≥ III (OR 1.84, 95% CI 1.33-2.55), cardiogenic shock (OR 4.15, 95% CI 3.06-5.64), prosthetic valve (OR 1.98, 95% CI 1.68-2.33), multivalvular affection (OR 1.35, 95% CI 1.01-1.82), renal failure (OR 2.57, 95% CI 2.15-3.06), paravalvular abscess (OR 2.39, 95% CI 1.77-3.22) and S. aureus infection (OR 2.27, 95% CI 1.89-2.73). CONCLUSIONS After a systematic review, we identified 11 preoperative factors related to an increased postoperative mortality. The meta-analysis of each of these factors showed a significant association with an increased in-hospital mortality after surgery for active infective endocarditis. Graph summary of the Pooled Odds Ratios of the 11 preoperative factors analyzed after the systematic review and meta-analysis.
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Jia YX, Li Y, Meng X, Xu CL, Zeng W, Jiao YQ, Han W, Sun H. Clinical Analysis of 161 Cases of Surgical Treatment of Infective Endocarditis. Surg Infect (Larchmt) 2019; 20:637-642. [PMID: 31120386 DOI: 10.1089/sur.2019.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the diagnostic criteria, surgical indications, and prognostic factors in the surgical treatment of infective endocarditis (IE). Methods: A total of 161 cases of post-operative IE treated at our hospital from January 2007 to December 2016 were included. The IE was diagnosed by the modified Duke criteria. Echocardiography and standard blood cultures were performed. These cases were divided into severe and non-severe adverse event groups. The association between prognostic factors and severe versus non-severe outcomes was examined using logistic regression. Results: Thirty patients (20.1%) with post-operative IE had positive pre-operative blood cultures, and 130 patients (80.7%) had valve vegetations. Four patients (2.5%) died within 30 days post-operatively. Twenty-two patients experienced severe adverse events. There were significant differences between the two groups regarding their serum albumin and creatinine concentrations, ejection fraction, and hospitalization, cardiopulmonary bypass, aortic cross-clamp, intensive care unit (ICU), and ventilation times (all p < 0.05). The bypass time, aortic cross-clamp time, and ICU time were identified as prognostic factors for severe adverse events. Conclusion: Echocardiography is an important diagnostic method for IE, and repeated tests might improve the sensitivity of diagnosis. Cardiac surgery seems to be an effective treatment for IE. Patient screening and reducing the operative time may improve the prognosis for patients who undergo surgical treatment for IE.
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Affiliation(s)
- Yi-Xin Jia
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chun-Lei Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wen Zeng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yu-Qing Jiao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Han
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - He Sun
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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44
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[Treatment of infectious endocarditis]. Presse Med 2019; 48:539-548. [PMID: 31109766 DOI: 10.1016/j.lpm.2019.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/07/2019] [Accepted: 04/21/2019] [Indexed: 11/21/2022] Open
Abstract
Antibiotic treatment of infective endocarditis is part of a multidisciplinary patient management that should be conducted within an "Endocarditis team". Initial antibiotic treatment of infective endocarditis should be parenteral and comply with current international guidelines. A switch to an oral antibiotic regimen may be considered after 2weeks of successful parenteral antibiotic treatment. Aminoglycosides should no longer be used for the initial treatment of native valve Staphylococcus aureus endocarditis. Valve surgery is required in almost half of the patients.
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Gatti G, Sponga S, Peghin M, Givone F, Ferrara V, Benussi B, Mazzaro E, Perrotti A, Bassetti M, Luzzati R, Chocron S, Pappalardo A, Livi U. Risk scores and surgery for infective endocarditis: in search of a good predictive score. SCAND CARDIOVASC J 2019; 53:117-124. [PMID: 31007096 DOI: 10.1080/14017431.2019.1610188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objectives: To evaluate scoring systems that have been created to predict the risk of death post-surgery in infective endocarditis (IE). Design: Eight scores - (1) The Society of Thoracic Surgery (STS) risk score for IE, (2) De Feo score, (3) PALSUSE score (prosthetic valve, age ≥70, large intracardiac destruction, Staphylococcus spp, urgent surgery, sex [female], EuroSCORE ≥10), (4) ANCLA score (anemia, New York Heart Association class IV, critical state, large intracardiac destruction, surgery of thoracic aorta), (5) Risk-Endocarditis Score (RISK-E), (6) score for heart valve or prosthesis IE (EndoSCORE), and (7,8) Association pour l'Étude et la Prévention de l'Endocadite Infectieuse (AEPEI) score I and II - were evaluated in 324 (mean age, 61.8 ± 14.6 years) consecutive patients having IE and undergoing cardiac operation (1999-2018, Regione Autonoma Friuli-Venezia Giulia, Italy). Results: There were 45 (13.9%) in-hospital deaths. Despite many differences on the number and the type of variables, all the investigated scores showed good goodness-of-fit (Hosmer-Lemeshow test, p ≥.28). For five scores, accuracy of prediction (receiver-operating characteristic curve analysis) was good (ANCLA score) or fair (STS risk score for IE, PALSUSE score, AEPEI score I and II). When compared one-to-one (Hanley-McNeil method), accuracy of prediction of ANCLA score was higher than all of other risk scores except for AEPEI score I (p = .077). Conclusions: Five of eight scores that were evaluated in this study showed satisfactory performance in predicting in-hospital mortality following surgery for IE. The ANCLA score should be preferred.
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Affiliation(s)
- Giuseppe Gatti
- a Cardio-Thoracic and Vascular Department , University Hospital of Trieste , Trieste , Italy
| | - Sandro Sponga
- b Department of Cardio-Thoracic Surgery , University Hospital of Udine , Udine , Italy
| | - Maddalena Peghin
- c Department of Infective Diseases , University Hospital of Udine , Udine , Italy
| | - Filippo Givone
- c Department of Infective Diseases , University Hospital of Udine , Udine , Italy
| | - Veronica Ferrara
- b Department of Cardio-Thoracic Surgery , University Hospital of Udine , Udine , Italy
| | - Bernardo Benussi
- a Cardio-Thoracic and Vascular Department , University Hospital of Trieste , Trieste , Italy
| | - Enzo Mazzaro
- b Department of Cardio-Thoracic Surgery , University Hospital of Udine , Udine , Italy
| | - Andrea Perrotti
- d Department of Thoracic and Cardiovascular Surgery , University Hospital Jean Minjoz , Besançon , France
| | - Matteo Bassetti
- c Department of Infective Diseases , University Hospital of Udine , Udine , Italy
| | - Roberto Luzzati
- e Department of Infective Diseases , University Hospital of Trieste , Trieste , Italy
| | - Sidney Chocron
- d Department of Thoracic and Cardiovascular Surgery , University Hospital Jean Minjoz , Besançon , France
| | - Aniello Pappalardo
- a Cardio-Thoracic and Vascular Department , University Hospital of Trieste , Trieste , Italy
| | - Ugolino Livi
- b Department of Cardio-Thoracic Surgery , University Hospital of Udine , Udine , Italy
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Elbatarny M, Bahji A, Bisleri G, Hamilton A. Management of endocarditis among persons who inject drugs: A narrative review of surgical and psychiatric approaches and controversies. Gen Hosp Psychiatry 2019; 57:44-49. [PMID: 30908961 DOI: 10.1016/j.genhosppsych.2019.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND People who inject drugs (PWID) represent a high-risk subgroup of endocarditis patients. This is highlighted by poorer post-operative outcomes in injection drug use-related infective endocarditis (IDU-IE), which is largely attributable to the increased vulnerability of prosthetic valves to re-infection. Consequently, many centres do not perform valve replacement on these patients. A parallel, but often underrecognized, component of care is the role of multidisciplinary management for individuals with IDU-IE, including perioperative addictions and psychiatric care. Consequently, surgical management options in IDU-IE remain a controversial topic. OBJECTIVES To determine the characteristics of optimal surgical and psychiatric care for individuals with IDU-IE. METHODS We conducted a narrative synthesis of the findings of literature retrieved from searches of computerized databases, hand searches, and authoritative text, organizing the findings into several key themes: clinical characteristics and factors associated with mortality in IDU-IE, alternative surgical management options, perioperative risk stratification techniques, principles of psychiatric and addictions management in IDU-IE, ethical considerations and controversies, and future research directions. RESULTS/CONCLUSIONS Managing IDU-IE involves the treatment of two comorbidities: the intra-cardiac infection and the underlying substance use disorder. Cardiac surgery represents a high-intensity intervention with appreciable risk, and the benefit it is not always clear. As patients often present acutely, it is not feasible to use drug abstinence as a prerequisite to surgery. Involvement of inpatient psychiatry and addictions teams, however, appears to be an evidence-based approach that can bridge IDU-IE patients with opioid agonist therapy in hospital and adequate outpatient treatment options for their underlying addiction upon their discharge from hospital. It is likely that a majority of these patients are not receiving optimal psychiatric management despite increasing recognition of efficacy. Further interdisciplinary studies are needed to elucidate optimal surgical and multidisciplinary protocols. BACKGROUND Infective endocarditis (IE) is an infection of the innermost lining of the heart often affecting the heart valves. Over the last few decades, the epidemiology of IE has shifted in the developed world and while it continues to be a significant cause of morbidity and mortality, there has been a significant increased incidence among persons who inject drugs (PWID). To date, well-conducted epidemiologic studies of IE among PWID have been sparse, which has limited our ability to fully characterize this disease phenomenon. To address this knowledge deficit, we conducted a narrative synthesis of the findings of literature retrieved from searches of computerized databases, hand searches, and authoritative text, and organized our findings into six key themes: clinical characteristics and factors associated with mortality in IDU-IE, alternative surgical management options, perioperative risk stratification techniques, principles of psychiatric and addictions management in IDU-IE, ethical considerations and controversies, and future research directions.
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Affiliation(s)
- Malak Elbatarny
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Anees Bahji
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Andrew Hamilton
- Division of Cardiac Surgery, Department of Surgery, Queen's University, Kingston, Ontario, Canada
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47
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Ramos-Martínez A, Calderón-Parra J, Miró JM, Muñoz P, Rodríguez-Abella H, Valerio M, de Alarcón A, Luque R, Ambrosioni J, Fariñas MC, Goenaga MÁ, Oteo JA, Martínez Marcos FJ, Vinuesa D, Domínguez F. Effect of the type of surgical indication on mortality in patients with infective endocarditis who are rejected for surgical intervention. Int J Cardiol 2019; 282:24-30. [PMID: 30718134 DOI: 10.1016/j.ijcard.2019.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/18/2018] [Accepted: 01/02/2019] [Indexed: 12/20/2022]
Abstract
AIM To evaluate the effect of the type of surgical indication on mortality in infective endocarditis (IE) patients who are rejected for surgery. METHODS AND RESULTS From January 2008 to December 2016, 2714 patients with definite left-sided IE were attended in the participating hospitals. One thousand six hundred and fifty-three patients (60.9%) presented surgical indications. Five hundred and thirty-eight patients (32.5%) presented surgical indications but received medical treatment alone. The indications for surgery in these patients were uncontrolled infection (366 patients, 68%), heart failure (168 patients, 31.3%) and prevention of embolism (148 patients, 27.6%). One hundred and thirty patients (24.2%) presented more than one indication. The mortality during hospital admission was 60% (323 patients). The in-hospital mortality of patients whose indication for surgery was heart failure, uncontrolled infection or risk of embolism was 75.6%, 61.4% and 54.7%, respectively (p < 0.001). Surgical indications due to heart failure (OR: 3.24; CI 95%: 1.99-5.9) or uncontrolled infection (OR: 1.83; CI 95%: 1.04-3.18) were independently associated with a fatal outcome during hospital admission. Mortality during the first year was 75.4%. The mortality during the first year in patients whose indication for surgery was heart failure, uncontrolled infection or risk of embolism was 85.9%, 76.7% and 72.7%, respectively (p = 0.016). Surgical indication due to heart failure (OR: 3.03; CI 95%: 1.53-5.98) were independently associated with fatal outcome during the first year. CONCLUSIONS The type of surgical indication is associated with mortality in IE patients who are rejected for surgical intervention.
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Affiliation(s)
- Antonio Ramos-Martínez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Jorge Calderón-Parra
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José Mª Miró
- Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Spain.
| | - Hugo Rodríguez-Abella
- Servicio de Cirugía Cardiaca, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maricela Valerio
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Spain
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Virgen del Rocío and Virgen Macarena, Seville, Spain
| | - Rafael Luque
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Virgen del Rocío and Virgen Macarena, Seville, Spain.
| | - Juan Ambrosioni
- Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
| | - Mª Carmen Fariñas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain.
| | - Miguel Ángel Goenaga
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián, Spain
| | - José Antonio Oteo
- Servicio de Enfermedades Infecciosas, Hospital San Pedro, Centro de Investigación Biomédica de La Rioja (CIBIR), Spain.
| | | | - David Vinuesa
- Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital Clínico San Cecilio, Granada, Spain
| | - Fernando Domínguez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Belletti A, Jacobs S, Affronti G, Mladenow A, Landoni G, Falk V, Schoenrath F. Incidence and Predictors of Postoperative Need for High-Dose Inotropic Support in Patients Undergoing Cardiac Surgery for Infective Endocarditis. J Cardiothorac Vasc Anesth 2018; 32:2528-2536. [DOI: 10.1053/j.jvca.2017.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Indexed: 12/15/2022]
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49
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Varela Barca L, López-Menéndez J, Navas Elorza E, Moya Mur JL, Centella Hernéndez T, Redondo Palacios A, Fajardo ER, Miguelena Hycka J, Martín García M, Muñoz Pérez R, Rodríguez-Roda Stuart J. Long-term prognosis after surgery for infective endocarditis: Distinction between predictors of early and late survival. Enferm Infecc Microbiol Clin 2018; 37:435-440. [PMID: 30470460 DOI: 10.1016/j.eimc.2018.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Cardiac surgery is a life-saving procedure in patients diagnosed with infective endocarditis (IE). There are several validated risk scores developed to predict early-mortality; nevertheless, long-term survival has been less investigated. The aim of the present study is to analyze the impact of IE-specific risk factors for early and long-term mortality. METHODS An observational retrospective study was conducted that included all patients who underwent surgery for IE from 2002 to 2016. Median follow-up time after surgery was 53.2 months (IQI 26.2-106.8 months). In-hospital mortality was analyzed using multiple logistic regression. Long-term survival was analyzed after one, two and five years. Cox proportional hazards regression was employed to identify risk factors related to long-term mortality. RESULTS Of the 180 patients underwent cardiac surgery, 133 were discharged alive (in-hospital mortality was 26.11%). 6 variables were identified as independent factors associated with in-hospital mortality, most of them closely related to the severity of IE: age, multivalvular involvement, critical preoperative status, preoperative mechanical ventilation, abscess and thrombocytopenia. Long-term survival in patients discharged alive was 89.1%, 87.4% and 77.6% after one, two and five years. Long-term mortality was independent of specific IE factors and 86.51% of deaths were not related to cardiovascular or infectious diseases. CONCLUSION Despite the high perioperative mortality rate after surgical treatment for active IE, long-term survival after hospital discharge was acceptable, regardless of the severity of the endocarditis episode. Although in-hospital survival depended mainly on several IE factors, long-term survival was not related to the severity of endocarditis baseline affection.
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50
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Fernández-Hidalgo N, Ferreria-González I, Marsal JR, Ribera A, Aznar ML, de Alarcón A, García-Cabrera E, Gálvez-Acebal J, Sánchez-Espín G, Reguera-Iglesias JM, De La Torre-Lima J, Lomas JM, Hidalgo-Tenorio C, Vallejo N, Miranda B, Santos-Ortega A, Castro MA, Tornos P, García-Dorado D, Almirante B. A pragmatic approach for mortality prediction after surgery in infective endocarditis: optimizing and refining EuroSCORE. Clin Microbiol Infect 2018; 24:1102.e7-1102.e15. [PMID: 29408350 DOI: 10.1016/j.cmi.2018.01.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/13/2018] [Accepted: 01/20/2018] [Indexed: 01/13/2023]
Abstract
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.
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Affiliation(s)
- N Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - I Ferreria-González
- Unitat d'Epidemiologia, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
| | - J R Marsal
- Unitat d'Epidemiologia, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Unitat de Suport a la Recerca Lleida-Pirineus, IDIAP Jordi Gol, Lleida, Spain
| | - A Ribera
- Unitat d'Epidemiologia, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - M L Aznar
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A de Alarcón
- Universitat Autònoma de Barcelona, Barcelona, Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain; Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain
| | - E García-Cabrera
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain
| | - J Gálvez-Acebal
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - G Sánchez-Espín
- Unidad de Gestión Clínica del Corazón, Instituto de Investigación Biomédica de Málaga (BIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - J M Reguera-Iglesias
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - J De La Torre-Lima
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - J M Lomas
- Unitat de Suport a la Recerca Lleida-Pirineus, IDIAP Jordi Gol, Lleida, Spain; Unidad de Enfermedades Infecciosas, Hospitales Juan Ramón Jiménez-Infanta Elena, Huelva, Spain
| | - C Hidalgo-Tenorio
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - N Vallejo
- Servicio de Cardiología, Grupo de Trabajo de Endocarditis Infecciosa, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - B Miranda
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Santos-Ortega
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M A Castro
- Servei de Cirurgia Cardíaca, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - P Tornos
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - D García-Dorado
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - B Almirante
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
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