'A pragmatic approach for mortality prediction after surgery in infective endocarditis' – Author's reply
Authors: I. Ferreira-González, N. Fernández-Hidalgo, A. Ribera
Journal: Clinical Microbiology and Infection (2018)

We appreciate the interest that Varela Barca et al. [[1]Varela Barca L. López-Menéndez J. Redondo Palacios A. Rodríguez-Roda J. A pragmatic approach for mortality prediction after surgery in infective endocarditis' by Ferreira-González, et al.Clin Microbiol Infect. 2018; 24: 1351-1353Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] have shown regarding our study [[2]Fernandez-Hidalgo N. Ferreria-Gonzalez I. Marsal J.R. Ribera A. Aznar M.L. de Alarcon A. et al.A pragmatic approach for mortality prediction after surgery in infective endocarditis: optimizing and refining EuroSCORE.Clin Microbiol Infect. 2018; 24: 1102e7-1103e15Abstract Full Text Full Text PDF Scopus (18) Google Scholar] performing an external validation of the original and endocarditis-specific versions of EuroSCORE I and EuroSCORE II models in their cohort of operated IE patients. There are relevant similarities and differences between the two cohorts. In both groups, 30-day postoperative mortality was the same and mitral involvement was a risk factor for mortality. However, a fistula was less frequent in the external validation cohort, whereas multiple valve involvement, which emerged as a significant predictive factor in the external validation sample, was not included in our specific models. Besides, the preoperative risk calculated by the original score was much lower in our study. Unfortunately, the authors do not provide enough information to find an explanation for such differences, although the retrospective design, sample size, and temporal bias, factors that may affect both cohorts, could be possible causes. The retrospective design of our study entailed several limitations that were recognized in the article. Specifically, our cohort may not reflect current risk of surgery of IE due to a temporal bias (we had included patients since 2000); variables from three different databases had to be homogenized; and relevant variables that had not been prospectively collected could not be entered into the model. Despite all limitations, in the external validation cohort, calibration improved with the new Specific EuroSCORE II. As we conclude in our article, an external and prospective validation of these models is mandatory. In this sense, we are developing a prospective multinational study in which we hope to collect the maximum number of surgeries in the shortest possible time. In the meanwhile, we really appreciate the efforts made with this first approach to assess the validity of modified EuroSCORES in an external cohort. Although modest, the improvement shown in global performance it enhances the necessity of a prospective multicentric validation cohort. Although surgery risk scores should not exclusively drive individual decisions, their utility to assess the performance of the intervention at the level of Departments and Health Care systems is well established. Given the current lack of reliable scores for the IE surgery, we encourage all centres interested in participating in our project to contact us. Re: ‘A pragmatic approach for mortality prediction after surgery in infective endocarditis’ by Ferreira-González, et al.Clinical Microbiology and InfectionVol. 24Issue 12PreviewWe have read with special interest the recently published article by Fernández-Hidalgo et al. [1] about optimizing and refining EuroSCORE in infective endocarditis (IE) surgery. Full-Text PDF Open ArchiveA pragmatic approach for mortality prediction after surgery in infective endocarditis: optimizing and refining EuroSCOREClinical Microbiology and InfectionVol. 24Issue 10PreviewTo simplify and optimize the ability of EuroSCORE I and II to predict early mortality after surgery for infective endocarditis (IE). Full-Text PDF Open Archive