Prognostic assessment of valvular surgery in active infective endocarditis: multicentric nationwide validation of a new score developed from a meta-analysis.
Por:
Varela Barca L, Fernández-Felix BM, Navas Elorza E, Mestres CA, Muñoz P, Cuerpo-Caballero G, Rodríguez-Abella H, Montejo-Baranda M, Rodríguez-Álvarez R, Gutiérrez Díez F, Goenaga MA, Quintana E, Ojeda-Burgos G, de Alarcón A, Vidal-Bonet L, Centella Hernández T, López-Menéndez J and Spanish Collaboration on Endocarditis—Grupo de Apoyo al Manejo de la Endocarditi
Publicada:
1 abr 2020
Resumen:
OBJECTIVES: Several risk prediction models have been developed to estimate the risk of mortality after valve surgery for active infective endocarditis (IE), but few external validations have been conducted to assess their accuracy. We previously developed a systematic review and meta-analysis of the impact of IE-specific factors for the in-hospital mortality rate after IE valve surgery, whose obtained pooled estimations were the basis for the development of a new score (APORTEI). The aim of the present study was to assess its prognostic accuracy in a nationwide cohort. METHODS: We analysed the prognostic utility of the APORTEI score using patient-level data from a multicentric national cohort. Patients who underwent surgery for active IE between 2008 and 2018 were included. Discrimination was evaluated using the area under the receiver operating characteristic curve, and the calibration was assessed using the calibration slope and the Hosmer-Lemeshow test. Agreement between the APORTEI and the EuroSCORE I was also analysed by Lin's concordance correlation coefficient (CCC), the Bland-Altman agreement analysis and a scatterplot graph. RESULTS: The 11 variables that comprised the APORTEI score were analysed in the sample. The APORTEI score was calculated in 1338 patients. The overall observed surgical mortality rate was 25.56%. The score demonstrated adequate discrimination (area under the receiver operating characteristic curve = 0.75; 95% confidence interval 0.72-0.77) and calibration (calibration slope = 1.03; Hosmer-Lemeshow test P = 0.389). We found a lack of agreement between the APORTEI and EuroSCORE I (concordance correlation coefficient = 0.55). CONCLUSIONS: The APORTEI score, developed from a systematic review and meta-analysis, showed an adequate estimation of the risk of mortality after IE valve surgery in a nationwide cohort.
Filiaciones:
Varela Barca L:
Department of Cardiovascular Surgery, University Hospital Son Espases, Palma de Mallorca, Spain
University of Alcalá de Henares, Madrid, Spain
Fernández-Felix BM:
University of Alcalá de Henares, Madrid, Spain
CIBER Epidemiology and Public Health (CIBERESP), Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS), Madrid, Spain
Navas Elorza E:
Department of Infectology, University Hospital Ramon y Cajal, Madrid, Spain
Mestres CA:
Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
Muñoz P:
CIBER Enfermedades Respiratorias-CIBERES, Instituto de Salud Carlos III, Madrid, Spain
Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón-Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
Cuerpo-Caballero G:
Department of Cardiovascular Surgery, University Hospital Gregorio Marañón, Madrid, Spain
Rodríguez-Abella H:
Department of Cardiovascular Surgery, University Hospital Gregorio Marañón, Madrid, Spain
Montejo-Baranda M:
Department of Infectology, University Hospital Cruces, Bilbao, Spain
Rodríguez-Álvarez R:
Department of Cardiovascular Surgery, University Hospital Marques de Valdecilla, Santander, Spain
Gutiérrez Díez F:
Department of Infectology, University Hospital Donosti, San Sebastian, Spain
Goenaga MA:
Department of Infectology, University Hospital Donosti, San Sebastian, Spain
Quintana E:
Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Ojeda-Burgos G:
Department of Infectology, University Hospital Virgen de la Victoria, Malaga, Spain
de Alarcón A:
Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville, CSIC, University Hospital Virgen del Rocío, Seville, Spain
Vidal-Bonet L:
Department of Cardiovascular Surgery, University Hospital Son Espases, Palma de Mallorca, Spain
Centella Hernández T:
University of Alcalá de Henares, Madrid, Spain
Department of Cardiovascular Surgery, University Hospital Ramon y Cajal, Madrid, Spain
López-Menéndez J:
University of Alcalá de Henares, Madrid, Spain
Department of Cardiovascular Surgery, University Hospital Ramon y Cajal, Madrid, Spain
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