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The Scientific World Journal
Volume 2012, Article ID 307571, 8 pages
http://dx.doi.org/10.1100/2012/307571
Clinical Study

The Need for a Specific Risk Prediction System in Native Valve Infective Endocarditis Surgery

1Department of Cardiothoracic Sciences, Second University of Naples, c/o V Monaldi Hospital, Via L. Bianchi, 80131 Naples, Italy
2Department of Cardiovascular Surgery, “Pineta Grande” Hospital, 81030 Castel Volturno, Italy

Received 8 October 2011; Accepted 2 November 2011

Academic Editor: Danny Chu

Copyright © 2012 Marisa De Feo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The need for a specific risk score system for infective endocarditis (IE) surgery has been previously claimed. In a single-center pilot study, preliminary to future multicentric development and validation, bivariate and multivariate (logistic regression) analysis of early postoperative mortality predictors in 440 native valve IE patients were performed. Mathematical procedures assigned scores to the independent predictors emerged (AUC of the ROC curve: 0.88). Overall mortality was 9.1%. Six predictors were identified and assigned scores, including age (5–13 points), renal failure (5), NYHA class IV (9), critical preoperative state (11), lack of preoperative attainment of blood culture negativity (5), perivalvular involvement (5). Four risk classes were drawn ranging from “very low risk” (≤5 points, mean predicted mortality 1%), and to “very high risk” (≥20 points, 43% mortality). IE-specific risk stratification models are both needed, as disease-specific factors (e.g., cultures, abscess), beside the generic ones (e.g., age, renal impairment) affect mortality, and feasible.