Valve surgery in active infective endocarditis: a simple score to predict in-hospital prognosis.
OBJECTIVE
Surgery for infective endocarditis (IE) is associated with high mortality. Our objectives were to describe the experience with surgical treatment for IE in Spain, and to identify predictors of in-hospital mortality.


METHODS
Prospective cohort of 1000 consecutive patients with IE. Data were collected in 26 Spanish hospitals.


RESULTS
Surgery was performed in 437 patients (43.7%). Patients treated with surgery were younger and predominantly male. They presented fewer comorbid conditions and more often had negative blood cultures and heart failure. In-hospital mortality after surgery was lower than in the medical therapy group (24.3 vs 30.7%, p=0.02). In patients treated with surgery, endocarditis involved a native valve in 267 patients (61.1%), a prosthetic valve in 122 (27.9%), and a pacemaker lead with no clear further valve involvement in 48 (11.0%). The most common aetiologies were Staphylococcus (186, 42.6%), Streptococcus (97, 22.2%), and Enterococcus (49, 11.2%). The main indications for surgery were heart failure and severe valve regurgitation. A risk score for in-hospital mortality was developed using 7 prognostic variables with a similar predictive value (OR between 1.7 and 2.3): PALSUSE: prosthetic valve, age ≥ 70, large intracardiac destruction, Staphylococcus spp, urgent surgery, sex [female], EuroSCORE ≥ 10. In-hospital mortality ranged from 0% in patients with a PALSUSE score of 0 to 45.4% in patients with PALSUSE score >3.


CONCLUSIONS
The prognosis of IE surgery is highly variable. The PALSUSE score could help to identify patients with higher in-hospital mortality.
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Europea de Madrid, Spain. Electronic address: mmselles@secardiologia.es.
Manuel
M
Martínez-Sellés
Department of Clinical Microbiology Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid, Spain.
Patricia
P
Muñoz
Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Ana
A
Arnáiz
Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain.
Mar
M
Moreno
Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain.
Juan
J
Gálvez
Department of Cardiovascular Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Jorge
J
Rodríguez-Roda
Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
Arístides
A
de Alarcón
Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
Emilio
E
García Cabrera
Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
María C
MC
Fariñas
Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Clínic de Barcelona, Spain; Universidad de Barcelona, Spain.
José M
JM
Miró
Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Cruces, Bilbao, Spain; Universidad del País Vasco, Spain.
Miguel
M
Montejo
Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Central de Asturias, Oviedo, Spain.
Alfonso
A
Moreno
Department of Internal Medicine, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
Josefa
J
Ruiz-Morales
Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Donosti, San Sebastián, Spain.
Miguel A
MA
Goenaga
Department of Clinical Microbiology Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid, Spain.
Emilio
E
Bouza
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality* / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index
Infective endocarditis; Prognosis; Risk stratification; Surgery