ABC | Volume 114, Nº3, March 2020

Original Article Pivatto Júnior et al. Risk scores for surgery in endocarditis Arq Bras Cardiol. 2020; 114(3):518-524 From 2000 to 2015, data from 2,715 patients with endocarditis (70.1% active) who underwent surgery at 26 Italian cardiac surgery centers were collected retrospectively. This large study 7 provided a logistic risk model to predict early mortality (within 30 days of surgery): the EndoSCORE. AUC was 0.84 (95%CI: 0.81-0.86). In our study, this score was tested to predict death during hospitalization, regardless of length of stay, and 5 of 31 deaths (16.1%) occurred beyond 30 days after surgery (early mortality: 24.3%). This difference seemed to have little effect on the performance of the score, which also underestimated early mortality (O/E ratio: 2.4; AUC: 0.77 [95%CI: 0.66-0.88]). The AEPEI score, 11 despite being IE-specific, does not include IE-specific variables in its final model. It was developed in a prospective study including 361 consecutive patients who had undergone surgery for IE (76.2% active) at eight European cardiac surgery centers. Fifty-six patients (15.5%) died after surgery, and the AUC was 0.78 (95%CI: 0.73-0.82). In the study population, the AEPEI score had equivalent discriminatory power to that of the EuroSCORE II (p = 0.4) and was found to be better than the logistic EuroSCORE (p = 0.0026) and PALSUSE (p = 0.047). Similarly to the AEPEI score, the STS-IE score 2 does not include IE-specific variables. It was developed from the Society of Thoracic Surgeons (STS) adult cardiac surgery database, which was established in 1989, including data from nearly 3 million cardiac procedures from over 90% of cardiac surgical centers in North America. From 2002 through 2008, 19,543 operations were performed for IE (51.5% active), with a mortality of 8.2%. The STS-IE score demonstrated good predictive ability, with an AUC of 0.76. Some limitations of our study should be mentioned. First, the retrospective design may have influenced the quality and consistency of the data collected. The relatively small sample size is also a source of concern. Finally, the fact that the study was conducted at a single center can limit the external validity of our findings. Conclusions Our results showed that, despite the availability of recent IE-specific scores and considering the trade-off between the indexes, the logistic EuroSCORE seemed to be the best predictor of mortality risk in our 10-year IE cohort, considering calibration (O/E ratio: 1.3) and discriminant ability (AUC 0.77). This finding has clinical implications, as the EuroSCORE II is the score most commonly used score in preoperative evaluation. Local validation of the new IE-specific scores for preoperative risk assessment in this specific group of patients is needed.  Author Contributions Conception and design of the research, analysis and interpretation of the data and writing of the manuscript: Pivatto Júnior F, Gus M; Acquisition of data: Pivatto Júnior F, Bellagamba CCA, Fernandes FS, Butzke M, Busato SB; Statistical analysis and obtaining financing: Pivatto Júnior F; Critical revision of the manuscript for intellectual content: Pivatto Júnior F, Bellagamba CCA, Pianca EG, Fernandes FS, Butzke M, Busato SB, Gus M. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding This study was funded by Fundo de Incentivo à Pesquisa e Eventos (FIPE) do Hospital de Clínicas de Porto Alegre (HCPA). Study Association This study is not associatedwith any thesis or dissertationwork. 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