Analysis of risk scores to predict mortality in patients undergoing cardiac surgery for infectious endocarditis at the Ibn Rochd university hospital in Casablanca, Morocco

Abstract

Risk scores are available for use in daily clinical practice, but knowing which one to choose is always fraught with pitfalls. To assess The logistic scores of EuroSCORE, EuroSCORE II and the specific scores of infectious endocarditis (IE) STS-IE, PALSUSE, AEPEI, EndoSCORE and RISK-E, as predictors of hospital mortality in patients undergoing cardiac surgery at the IBN ROCHD University Hospital in CASABLANCA,Morocco. Retrospective cohort study including all patients aged ≥ 18 years who underwent active CARDIAC surgery for EI in the study centre from 2015 to 2020. Scores were assessed by calibration (observed/expected mortality ratio [O/E]) and by discrimination (area below the ROC [AUC] curve). A P < 0.05 was considered statistically significant. A total of 157 patients were included. Overall hospital mortality was 29.0% (95% CI: 20.4 to 37.6%). The best O/E mortality ratio was obtained 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 EuroSCORE logistics had the highest discriminating power (AUC 0.77), which was significantly higher than EuroSCORE II ( P –0.03), STS-IE ( P –0.03), PALSUSE ( P –0.03), AEPEI ( P –0.03) and RISK-E ( P –0.02). Despite the availability of recent EI-specific scores, and given the trade-off between indices, EuroSCORE Logistics appeared to be the best predictor of mortality risk in our cohort, taking a calibration (mortality ratio O/E: 1.3) and discrimination (AUC 0.77). Local validation of IE-specific scores is needed to better assess preoperative surgical risk.