Komkrit KomuttarinMaharat Nakhon Ratchasima Hospital, Thailand
Title: Validation of Euroscore II cut-off at 12% for active infective endocarditis
Objective: Patients with Infective Endocarditis (IE) have a high risk of perioperative death. An accurate and reliable predictive score is crucial for decision making. The aim of this study is to externally validate Euroscore II, at a cut-off of 12%, in the prediction of hospital mortality.
Patients and Methods: Data were collected from medical records of patients who were diagnosed with active IE between June 1st 2017 and June 1st 2020. Preoperative Euroscore II was calculated. Patients were categorized into 2 groups according to Euroscore II: Those with scores < 12 and ? 12. The discriminatory ability using the cut-off value was determined from observed perioperative mortality.
Results: There were 43 patients diagnosed with active IE. None had prosthetic IE. Most were male (56%). The mean age was 47.7 years. Large vegetation was found in 89%. Only one patient had ejection fraction < 40%. The most common clinical manifestation was heart failure (81%). Around four-fifths had single valvular involvement (82%). The most affected site was the aortic valve (44%). Median time from diagnosis to surgery was 7.5 days. Median duration of aortic cross-clamp time and cardiopulmonary bypass time were 83 mins and 99 mins respectively. The mean Euroscore II was 8.6%. There was 7% mortality (3/43). All deaths occurred in patients with Euroscore II ? 12 (30% actual mortality in this group). By using cut-off value of Euroscore II at 12%, the area under the receiver operating characteristic curve was 91.3% (95% CI 85.3 – 97.2%).
Conclusion: This study confirmed the validity of using Euroscore II. 12% to help discriminate high-risk active IE patients. It might be accurate enough external to help decision-making for surgery in high-risk active IE patients in centers with similar circumstances.
Komkrit Komuttarin is a cardiothoracic surgeon with more than 14 years of experience. He completed resident program CVT from Chulalongkorn hospital after earning his MD from Khon Koen University. He was visiting clinical fellow of the Department of Cardiac Surgery at The University Hospital Heidelberg and completed postgraduate training in aortic surgery at aortic center, Kawasaki Saiwai hospital. He has interested infective endocarditis and has published 5 articles about the disease.