ABC | Volume 114, Nº3, March 2020

Original Article Analysis of Risk Scores to Predict Mortality in Patients Undergoing Cardiac Surgery for Endocarditis Fernando Pivatto Júnior, 1 C larissa Carmona de Azevedo Bellagamba, 1 Eduardo Gatti Pianca, 1 Fernando Schmidt Fernandes, 1 Maurício Butzke, 1 S tefano Boemler Busato, 1 Miguel Gus 1 Hospital de Clínicas de Porto Alegre, 1 Porto Alegre, RS – Brazil Mailing Address: Fernando Pivatto Júnior • Hospital de Clínicas de Porto Alegre - Rua Ramiro Barcelos, 2350. Postal Code 90035-903, Porto Alegre, RS – Brazil E-mail: fpivatto@gmail.com Manuscript received January 22, 2019, revised manuscript April 19, 2019, accepted June 03, 2019 Abstract Background: Risk scores are available for use in daily clinical practice, but knowing which one to choose is still fraught with uncertainty. Objectives: To assess the logistic EuroSCORE, EuroSCORE II, and the infective endocarditis (IE)-specific scores STS-IE, PALSUSE, AEPEI, EndoSCORE and RISK-E, as predictors of hospital mortality in patients undergoing cardiac surgery for active IE at a tertiary teaching hospital in Southern Brazil. Methods: Retrospective cohort study including all patients aged ≥ 18 years who underwent cardiac surgery for active IE at the study facility from 2007-2016. The scores were assessed by calibration evaluation (observed/expected [O/E] mortality ratio) and discrimination (area under the ROC curve [AUC]). Comparison of AUC was performed by the DeLong test. A p < 0.05 was considered statistically significant. Results: A total of 107 patients were included. Overall hospital mortality was 29.0% (95%CI: 20.4-37.6%). The best O/E mortality ratio was achieved by the PALSUSE score (1.01, 95%CI: 0.70-1.42), followed by the logistic EuroSCORE (1.3, 95%CI: 0.92-1.87). The logistic EuroSCORE had the highest discriminatory power (AUC 0.77), which was significantly superior to EuroSCORE II (p = 0.03), STS-IE (p = 0.03), PALSUSE (p = 0.03), AEPEI (p = 0.03), and RISK-E (p = 0.02). Conclusions: 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 cohort, taking calibration (O/E mortality ratio: 1.3) and discrimination (AUC 0.77) into account. Local validation of IE-specific scores is needed to better assess preoperative surgical risk. (Arq Bras Cardiol. 2020; 114(3):518-524) Keywords: Cardiovascular Surgical Procedures/mortality; Endocarditis/complications; Hospital Mortality; Risk Assessment. DOI: https://doi.org/10.36660/abc.20190050 Introduction Despite advances in medical and surgical treatment, infective endocarditis (IE) is associated with substantial morbidity and risk of death. 1 Surgical correction of active IE is associated with the highest mortality of any valve disease, with overall rates of in-hospital mortality exceeding 20%. 2 Surgery is currently performed in 50 to 60% of patients with IE. 3 The indications are: heart failure (usually related to valve dysfunction), uncontrolled infection (often associated with perivalvular extension and atrioventricular conduction defects), and prevention of systemic embolism. 4 Although these indications are clear, their practical application relies largely on the patient’s clinical status, comorbidities and operative risk. 5 Risk prediction models for cardiac surgery have been developed to provide information on risks for both clinicians and patients and to guide decision-making. 6 Assessment of surgical risk helps to measure the quality of healthcare service, and risk profile is essential to differentiate patients by severity of health status. Likewise, being aware of a patient’s risk can allow implementation of individualized strategies to prevent complications. 7 Although risk scores are available for use in daily clinical practice, knowing which one to choose is still fraught with uncertainty. Within this context, the aim of the present study was to assess the logistic EuroSCORE, 8 EuroSCORE II, 9 and the IE- specific scores STS-IE, 2 PALSUSE, 10 AEPEI, 11 EndoSCORE 7 and RISK-E, 12 as predictors of hospital mortality in patients undergoing cardiac surgery for active IE at a tertiary teaching hospital in Southern Brazil. Methods This retrospective cohort study included all patients aged ≥ 18 years who underwent cardiac surgery for active IE at Hospital de Clínicas de Porto Alegre (HCPA), a tertiary teaching hospital in Southern Brazil, from 2007 to 2016. Only patients 518