Comparisons of Risk Scores for Infective Endocarditis Surgery: A Meta-Analysis.

Abstract

While multiple scoring systems exist to predict mortality in cardiac surgery, their utility in infective endocarditis (IE) remains uncertain, prompting this study to compare their prognostic accuracy. We conducted a comprehensive review using Ovid Medline, Embase, and Cochrane Central Register of Controlled Trials. Data were pooled using Open-Meta[Analyst] software, and calibration analysis was performed with Review Manager 5.4. Among 620 articles identified, 570 were screened, leading to 15 included studies. Twelve risk scores were analyzed for operative mortality discrimination in IE surgery, with the area under the curve (AUC) ranging from 0.64 to 0.83. Among the IE-specific risk scores, AUCs (95% confidence interval) were highest for ANCLA (Anemia, NYHA class IV, critical state, large intracardiac destruction, surgery on thoracic aorta) 0.838 (0.803-0.873), AEPEI (Association pour l'Etude et la Prevention de l'Endocadite Infectieuse) 0.764 (0.726-0.802), RISK-E (Risk Endocarditis) (0.752 (0.662-0.842) and APORTEI (Análisis de los factores PROnósticos en el Tratamiento quirúrgico de la Endocarditis Infecciosa) 0.750 (0.726-0.774) scores. Regarding traditional risk scores, EuroSCORE II performed at 0.750 (0.725-0.775) but underestimated mortality compared with EuroSCORE I in calibration analysis. In conclusion, EuroSCORE II and several endocarditis-specific scores had moderate discrimination (AUC > 0.75) in predicting mortality after IE surgery.