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Underscoring the need for Infective Endocarditis risk stratification and management
Session:
Sessão de Posters 44 - Endocardite Infecciosa
Speaker:
Catarina Sena Silva
Congress:
CPC 2024
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.8 Infective Endocarditis - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Catarina Sena Silva; Ana Margarida Martins; Ana Beatriz Garcia; Catarina Simões de Oliveira; Ana Abrantes; Catarina Gregório; João Santos Fonseca; João Mendes Cravo; Diogo Rosa Ferreira; Pedro Carrilho Ferreira; Catarina de Sousa; Fausto J. Pinto
Abstract
<p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Introduction:</span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Infective endocarditis (IE) is still an infrequent yet life-threatening and disabling condition. </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Surgical intervention plays a crucial role in </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">IE, being required in almost half of patients. It </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">represents a potential curative adjunctive intevention, helping to avert progressive heart failure, irreversible structural damage and systemic embolization</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">. However, surgical therapy during the </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">active phase of IE poses significant risks. Prognostic scores aid in assessing the risk of in-hospital mortality, guiding decisions on surgery indications. </span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Aim: </span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">To assess the score with the best predictive value for in-hospital mortality in IE patients undergoing cardiac surgery at a tertiary hospital. </span></span></span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Methods:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt">We conducted a retrospective cohort study including all patients admitted with the diagnosis of IE (modified Duke criteria) who underwent cardiac surgery between 2010 and 2022. Clinical, ECG and procedural data were obtained. The SHARPENscore, EuroSCORE II, STS-IE, PALSUSE, AEPEI, ANCLA and RISK-E scores were evaluated. Predictive abilities of these seven scores were compared using area under the receiver operating characteristics (ROC) curve for in-hospital mortality. </span></span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Results:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt">A total of 53 patients were included (71,7% male sex, mean age 63,9 </span><span style="font-size:11.0pt"><span style="font-family:Symbol">±</span></span><span style="font-size:11.0pt">15,3 years). The main characteristics of the population are described in table 1. Most pts were submitted to valve replacement (73.6%). The main reason for surgical approach was severe valvular regurgitation (62.3%) followed by failure of antibiotic therapy (22.6%). The in-hospital mortality was 19%. The AEPEI score showed the best discriminative power (AUC 0.78, 95%CI: 0.62-0.94, p=0.005) among all evaluated surgical scores, followed by Euroscore II (AUC 0,769 95%CI 0,613-0,925, p=0.009) and PALSUSE (AUC 0,724 95%CI 0,55-0,89, p=0.029) (Fig.1B). However, when comparing scores amongst themselves, we found no statistically significant differences regarding their discriminative power.</span></span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Conclusion:</span></strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">In patients with IE undergoing surgery, a 19% mortality rate was found in our institution. Our results suggest that the </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">AEPEI was the best tool to predict in hospital mortality. </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">However, none of the applied scores demonstrated a significantly superior discriminative power, with the area under the curve (AUC-ROC) deemed reasonable at best. These findings highlight the need for better tailored and accurate scores in this population and the importance of individualized, multidisciplinary and experienced approach to manage these patients.</span></span></span></span></p>
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