Comparative Analysis Of STS And EuroSCORE Ⅱ Score In Predicting Postoperative Mortality In Patients With Infective Endocarditis

Objectives:The aim of this study was to compare the predictive value of the Society of thoracic surgeons score and the new European system for cardiac operative risk evaluation Ⅱ for postoperative mortality in adult patients with infective endocarditis.Methods:A total of 207 adult patients with infective endocarditis underwent cardiac surgery between Anuary 2013 to December 2019 was retrospectively collected from Department of Cardiovascular Surgery of Yan’an Hospital Affiliated to Kunming Medical University was included in the study.Using online calculator of the STS and EuroSCORE Ⅱ risk prediction models to perform risk scores and calculate their predicted mortality rates respectively.According to the STS scores,patients were divided into the low risk group(<3%),the medium risk group(3-8%)and the high risk group(≥8%).According to the EuroSCORE Ⅱ scores,patients were divided into the low risk group(<3%),the medium risk group(3-6%)and the high risk group(≥6%).The discrimination of the two scores system was evaluated using receiver operating characteristic curve(ROC)and area under the curve AUC,the Hosmer-Lemeshow goodness-of-fit test evaluates the calibration for predicting mortality.By comparing discrimination and calibration,predicting mortality and actual mortality to choose the best model.Results:Eight of 207 patients died early after operation,the actual early mortality rate was 3.4%.thirteen of 207 patients died in the long-term after operation,and the actual total mortality rate was 6.3%.The STS score predicted mortality was 2.6%in the whole group,the EuroSCORE Ⅱ score predicted mortality was 3.4%in the whole group.The area under the ROC curve(AUC)of STS and EuroSCORE Ⅱ for predicting the risk of early postoperative death was 0.804 and 0.813,the AUC for predicting total death was 0.699 and 0.728.The results showed that the two scores discriminated well for early mortality risk prediction,but poorly for total mortality risk prediction after cardiac surgery for IE.The calibration of STS score for early postoperative death in the whole group was poor(H-L P<0.05),EuroSCORE Ⅱ score had better calibration in the early postoperative period of IE(H-L P>0.05).STS score underestimates early postoperative mortality(2.6%vs.3.4%,P=0.023),The predicted mortality of the EuroSCORE Ⅱ score is close to the actual mortality in the early postoperative period(3.4%vs.3.4%,P=0.574).After risk stratification,the EuroSCORE Ⅱ high-risk group predicted mortality close to the actual mortality in the early postoperative period,and the other groups overestimated or underestimated their actual mortality.Conclusions:The EuroSCORE Ⅱ score is significantly better than the STS score in predicting the risk of early death after IE.The EuroSCORE Ⅱ score can be used to predict the risk of early postoperative death in patients with IE in our center and provide guidance for the selection of IE treatment decisions.