title: EuroSCORE II underestimates mortality after cardiac surgery for infective endocarditis.
abstract: OBJECTIVE
  To better select for patients who most likely will benefit from cardiac surgery among those with infective endocarditis (IE), we aimed to identify preoperative markers associated with poor outcome after cardiac surgery for IE, and to evaluate the accuracy of European System for Cardiac Operative Risk Evaluation (EuroSCORE) II to predict mortality.
  
  
  METHODS
  We enrolled all adult patients who underwent cardiac surgery during the acute phase of definite IE (Duke Criteria) in two referral centres for cardiac surgery. Patients were identified through intensive care unit (ICU) electronic databases, and data were collected from medical charts on standardized questionnaire.
  
  
  RESULTS
  Between 2002 and 2013, 149 patients (117 males), with a median age of 64 years [interquartile range 52-73], fulfilled the inclusion criteria. Main complications before surgery were left ventricular dysfunction (23%), central nervous system symptomatic events (34%) and septic shock (24%). Most patients (95%) presented with valve regurgitation, and 49% had perivalvular abscess. Surgery was performed with a median delay of 12 days [5-24] after IE diagnosis, and mean EuroSCORE II was 15.8 (13.4-18.1). In-hospital mortality was 21%. Preoperative variables associated with mortality in multivariate analysis were obesity [odds ratio (OR) 3.67 [1.10-12.19], P = 0.03], vegetation >15 mm (OR 6.72 [1.46-30.98], P = 0.01), septic shock (OR 4.87 [1.67-14.28], P = 0.004) and mechanical prosthetic valve IE (OR 4.99 [1.72-28.57], P = 0.007). EuroSCORE II underestimated mortality in patients with predicted mortality over 10%.
  
  
  CONCLUSIONS
  Factors independently predictive of mortality after cardiac surgery for IE are obesity, septic shock, large vegetation and a mechanical prosthetic valve IE. EuroSCORE II underestimates post-cardiac surgery mortality in patients with IE.
authors.affiliation: Service de Réanimation Médicale et Infectieuse, CHU de Rennes - Hôpital Pontchaillou, Inserm, CIC-1414, Faculté de Médecine, Université Rennes I, Rennes, France.
authors.forename: Soléne
authors.initials: S
authors.lastname: Patrat-Delon
authors.affiliation: Service de Réanimation Médicale et de Médecine Hyperbare, CHU d'Angers, Angers, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Rouxel
authors.affiliation: Service de Réanimation Médicale et Infectieuse, CHU de Rennes - Hôpital Pontchaillou, Inserm, CIC-1414, Faculté de Médecine, Université Rennes I, Rennes, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Gacouin
authors.affiliation: Service de Réanimation Médicale et Infectieuse, CHU de Rennes - Hôpital Pontchaillou, Inserm, CIC-1414, Faculté de Médecine, Université Rennes I, Rennes, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Revest
authors.affiliation: Département de Chirurgie Thoracique et Cardiovasculaire, CHU de Rennes - Hôpital Pontchaillou, Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Flécher
authors.affiliation: Département de Chirurgie Thoracique et Cardiovasculaire, CHU d'Angers, Angers, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fouquet
authors.affiliation: Service de Réanimation Médicale et Infectieuse, CHU de Rennes - Hôpital Pontchaillou, Inserm, CIC-1414, Faculté de Médecine, Université Rennes I, Rennes, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Le Tulzo
authors.affiliation: Service de Réanimation Médicale et de Médecine Hyperbare, CHU d'Angers, Angers, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lerolle
authors.affiliation: Service de Réanimation Médicale et Infectieuse, CHU de Rennes - Hôpital Pontchaillou, Inserm, CIC-1414, Faculté de Médecine, Université Rennes I, Rennes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.affiliation: Service de Réanimation Médicale et Infectieuse, CHU de Rennes - Hôpital Pontchaillou, Inserm, CIC-1414, Faculté de Médecine, Université Rennes I, Rennes, France jean-marc.tadie@chu-rennes.fr.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Tadié
mesh_terms: D000368:Aged; D004697:Endocarditis, Bacterial / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index
keywords: EuroSCORE II; Infective endocarditis; Mortality; Surgery