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A2SHES Score: A novel simplified risk score for predicting in-hospital mortality in Infective Endocarditis
Session:
Posters (Sessão 2 - Écran 8) - Endocardite
Speaker:
Pedro Rocha Carvalho
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.8 Infective Endocarditis - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Pedro Rocha Carvalho; Isabel Moreira; Marta Catarina Bernardo; Catarina Carvalho; Fernando Gonçalves; José Paulo Fontes; Ilídio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Infective endocarditis (IE) is associated with high in-hospital mortality, despite improvements in therapeutic strategies. Moreover, there is a paucity of studies regarding the assessment of short-term prognosis in these patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> To develop a simplified risk score to predict in-hospital mortality.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>This was a retrospective study that included all patients hospitalized in a single center with the diagnosis of infective endocarditis, between 2005 and 2020. Patients with possible or definite IE were included in the analyses. The selection of variables for the score in our population was based on multivariable Binary logistic regression models. The accuracy of the logistic regression models was assessed using C-statistic and Hosmer-Lemeshow test. The optimal A<sub>2</sub>SHES Score cutoff was determined according to ROC curve analysis. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients were categorized into two groups based on their initial A<sub>2</sub>SHES Score. Baseline characteristics, management, and outcomes were compared between the two groups. The primary endpoint was in-hospital mortality and the secondary endpoint was 5-year mortality.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>A total of 145 patients were included in this study with a mean age of 67±16 years, 64.8% male, and 85,5% presenting with left-sided IE. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">After a multivariable binary Logistic regression analysis, six variables were associated with in-hospital mortality and were included in the risk score: <strong>A</strong>ge > 70 years, presence of <strong>A</strong>bscess, <strong>S</strong>taphylococcus aureus infection, previous <strong>H</strong>eart failure, splenic <strong>E</strong>mbolization, and septic <strong>S</strong>hock. Based on ROC analysis, which showed AUC=0,794, the optimal A<sub>2</sub>SHES Score was 3 (with a sensitivity of 60% and a specificity of 88%). Furthermore, the calibration by Hosmer-Lemeshow was 0.974. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The adjusted probability of in-hospital mortality for patients with A<sub>2</sub>SHES Score ≥3 was 82,3%. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In a multivariate regression analysis, after adjusting for valve surgery, A<sub>2</sub>SHES Score≥3 was an independent predictor of in-hospital death (HR 10,51, 95% CI: 3,9-18,33, p<0,001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">At five years follow-ups, using a Kaplan-Meyer survival analysis, mortality was higher in patients with A<sub>2</sub>SHES Score ≥3 (log-rank p=0,001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion(s): </strong>Our risk score provides an accurate estimation of in-hospital mortality in patients with infective endocarditis and had excellent discriminative power in follow-up. Nevertheless, external validation in a larger population is still needed. </span></span></p>
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