Using surgical risk scores in nonsurgically treated infective endocarditis patients

Abstract

The accuracy of surgical scores in predicting in-hospital mortality for nonsurgically treated patients with infective endocarditis (IE) has not yet been explored. Our goal is to establish scores to predict hospital mortality for patients with infective endocarditis who have not been treated with surgery. Patients with definite IE who did not undergo valve surgery were selected from the database from the database of the Ibn Rochd Casablanca University Hospital. The patients were scored using six systems specifically devised to predict in-hospital mortality after surgery for IE, three commonly used risk scores for heart surgery, and a ris k score for predicting six-month mortality in IE after either surgery or medical therapy. Calibration (Hosmer-Lemeshow test) and discriminatory power (receiver operating characteristic [ROC] analysis) were assessed for each score. Areas under ROC curves were compared one-to-one. A total of 192 patients (mean age, 65.2 ± 15.2 years) were considered for analysis. There were 38 (19.8%) in-hospital deaths. Age > 70 years (P = 0.001), Staphylococcus aureus as causal agent (P = 0.05), and severe sepsis (P = 0.027) were independent predictors of in-hospital mortality. Despite many differences in the number and type of variables, all but two of the investigated scores showed good calibration (P > 0.66). However, discriminatory power was satisfactory (area under ROC curve > 0.70) only for three of the scores specific for IE and two of the scores used to predict mortality after cardiac surgery. Among the 10 surgical scores evaluated in this study, five could be adopted to predict in-hospital mortality even for IE patients receiving medical treatment only.