title: A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE.
abstract: BACKGROUND
  The aim of this large retrospective study was to provide a logistic risk model along an additive score to predict early mortality after surgical treatment of patients with heart valve or prosthesis infective endocarditis (IE).
  
  
  METHODS
  From 2000 to 2015, 2715 patients with native valve endocarditis (NVE) or prosthesis valve endocarditis (PVE) were operated on in 26 Italian Cardiac Surgery Centers. The relationship between early mortality and covariates was evaluated with logistic mixed effect models. Fixed effects are parameters associated with the entire population or with certain repeatable levels of experimental factors, while random effects are associated with individual experimental units (centers).
  
  
  RESULTS
  Early mortality was 11.0% (298/2715); At mixed effect logistic regression the following variables were found associated with early mortality: age class, female gender, LVEF, preoperative shock, COPD, creatinine value above 2mg/dl, presence of abscess, number of treated valve/prosthesis (with respect to one treated valve/prosthesis) and the isolation of Staphylococcus aureus, Fungus spp., Pseudomonas Aeruginosa and other micro-organisms, while Streptococcus spp., Enterococcus spp. and other Staphylococci did not affect early mortality, as well as no micro-organisms isolation. LVEF was found linearly associated with outcomes while non-linear association between mortality and age was tested and the best model was found with a categorization into four classes (AUC=0.851).
  
  
  CONCLUSIONS
  The following study provides a logistic risk model to predict early mortality in patients with heart valve or prosthesis infective endocarditis undergoing surgical treatment, called "The EndoSCORE".
authors.affiliation: Cardiac Surgery, University "G. D'Annunzio" Chieti-Pescara, Chieti, Italy. Electronic address: mdimauro1973@gmail.com.
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
authors.affiliation: Cardiac Surgery, Mauriziano Hospital, Turin, Italy.
authors.forename: Guglielmo Mario Actis
authors.initials: GMA
authors.lastname: Dato
authors.affiliation: Cardiac Surgery, S. Croce Hospital, Cuneo, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Barili
authors.affiliation: Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.affiliation: Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santè
authors.affiliation: Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
authors.forename: Alessandro Della
authors.initials: AD
authors.lastname: Corte
authors.affiliation: Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Carrozza
authors.affiliation: Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
authors.forename: Ester Della
authors.initials: ED
authors.lastname: Ratta
authors.affiliation: Cardiac Surgery, AO, Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Cugola
authors.affiliation: Cardiac Surgery, AO, Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Galletti
authors.affiliation: Cardiac Surgery, Mauriziano Hospital, Turin, Italy.
authors.forename: Roger
authors.initials: R
authors.lastname: Devotini
authors.affiliation: Cardiac Surgery, Mauriziano Hospital, Turin, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casabona
authors.affiliation: Cardiac Surgery, IRCCS San Martino-IST, University Hospital, Genova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.affiliation: Cardiac Surgery, IRCCS San Martino-IST, University Hospital, Genova, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Salsano
authors.affiliation: Cardiac Surgery, Sacco Hospital, University of Milan, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Scrofani
authors.affiliation: Cardiac Surgery, Sacco Hospital, University of Milan, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Antona
authors.affiliation: Cardiac Surgery, Niguarda Hospital, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Botta
authors.affiliation: Cardiac Surgery, Niguarda Hospital, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Russo
authors.affiliation: Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: Samuel
authors.initials: S
authors.lastname: Mancuso
authors.affiliation: Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.affiliation: Cardiac Surgery, San Donato IRCCS Hospital, San Donato Milanese, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: De Vincentiis
authors.affiliation: Cardiac Surgery, San Donato IRCCS Hospital, San Donato Milanese, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Biondi
authors.affiliation: Cardiac Surgery, University Hospital, Varese, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Beghi
authors.affiliation: Cardiac Surgery, University Hospital, Varese, Italy.
authors.forename: Giangiuseppe
authors.initials: G
authors.lastname: Cappabianca
authors.affiliation: Cardiac Surgery, University Hospital, Padua, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tarzia
authors.affiliation: Cardiac Surgery, University Hospital, Padua, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.affiliation: Cardiac Surgery, San Raffaele IRCCS Hospital, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.affiliation: Cardiac Surgery, San Raffaele IRCCS Hospital, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pozzoli
authors.affiliation: Cardiac Surgery, Maggiore University Hospital, University of Parma, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nicolini
authors.affiliation: Cardiac Surgery, Maggiore University Hospital, University of Parma, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Benassi
authors.affiliation: Cardiac Surgery, S. Croce Hospital, Cuneo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Rosato
authors.affiliation: Cardiac Surgery, S. Croce Hospital, Cuneo, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Grasso
authors.affiliation: Cardiac Surgery, S. Maria Misericordia Hospital, University of Udine, Udine, Italy.
authors.forename: Ugolino
authors.initials: U
authors.lastname: Livi
authors.affiliation: Cardiac Surgery, S. Maria Misericordia Hospital, University of Udine, Udine, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Sponga
authors.affiliation: Cardiac Surgery, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.affiliation: Cardiac Surgery, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.affiliation: Cardiac Surgery, AO Pisana University Hospital, University of Pisa, Pisa, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: De Martino
authors.affiliation: Cardiac Surgery, AO Pisana University Hospital, University of Pisa, Pisa, Italy.
authors.forename: Uberto
authors.initials: U
authors.lastname: Bortolotti
authors.affiliation: Cardiac Surgery, University Hospital, University of Verona, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.affiliation: Cardiac Surgery, University Hospital, University of Verona, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
authors.affiliation: Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.affiliation: Cardiac Surgery, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizzardi
authors.affiliation: Cardiac Surgery, University "G. D'Annunzio" Chieti-Pescara, Chieti, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Di Giammarco
authors.affiliation: Cardiac Surgery, University "G. D'Annunzio" Chieti-Pescara, Chieti, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marinelli
authors.affiliation: Cardiac Surgery, Poliambulanza Hospital, Brescia, Italy.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Villa
authors.affiliation: Cardiac Surgery, Poliambulanza Hospital, Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Troise
authors.affiliation: Cardiac Surgery, San Camillo-Forlanini Hospital, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Picichè
authors.affiliation: Cardiac Surgery, San Camillo-Forlanini Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Musumeci
authors.affiliation: Cardiac Surgery, University Hospital, University "Aldo Moro", Bari, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Paparella
authors.affiliation: Cardiac Surgery, University Hospital, University "Aldo Moro", Bari, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Margari
authors.affiliation: Cardiac Surgery, S. Anna e S. Sebastiano Hospital, Caserta, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tritto
authors.affiliation: Cardiac Surgery, S. Anna e S. Sebastiano Hospital, Caserta, Italy.
authors.forename: Girolamo
authors.initials: G
authors.lastname: Damiani
authors.affiliation: Cardiac Surgery, Vito Fazi Hospital, Lecce, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scrascia
authors.affiliation: Cardiac Surgery, Vito Fazi Hospital, Lecce, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Zaccaria
authors.affiliation: Cardiac Surgery, University Hospital, University "Magna Grecia", Catanzaro, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Renzulli
authors.affiliation: Cardiac Surgery, University Hospital, University "Magna Grecia", Catanzaro, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Serraino
authors.affiliation: Cardiac Surgery, University of Leicester, Leicester, United Kingdom.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.affiliation: Cardiac Surgery, S. Anna Hospital, Catanzaro, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Maselli
authors.affiliation: Cardiac Surgery, University "G. D'Annunzio" Chieti-Pescara, Chieti, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Foschi
authors.affiliation: Cardiac Surgery, San Donato IRCCS Hospital, San Donato Milanese, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Parolari
authors.affiliation: Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
authors.forename: Giannantonio
authors.initials: G
authors.lastname: Nappi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000401:mortality* / Q000639:trends; D004696:Endocarditis / Q000175:diagnosis* / Q000401:mortality*; D005260:Female; D006350:Heart Valve Prosthesis / Q000382:microbiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000401:mortality*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Infective endocarditis; Risk score; Valve surgery