Olmos et al developed the RISK-E score for predicting mortality after surgery for active left-sided endocarditis based on preoperative factors. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in Spain and France.
Patient selection: active infective left-sided endocarditis
Outcome: postoperative mortality
Parameters:
(1) age in years
(2) prosthetic endocarditis
(3) virulent micro-organism (Staphylococcus aureus, fungi)
(4) septic shock
(5) thrombocytopenia (platelet count < 150,000 per µL)
(6) acute renal insufficiency
(7) cardiogenic shock
(8) periannular complications (abscess, fistula, pseudoaneurysm, prosthetic dehiscence)
|
Parameter
|
Finding
|
beta-coefficient
|
Points
|
|
age
|
<= 51 years
|
0
|
0
|
|
|
52 to 63
|
0.916
|
9
|
|
|
64 to 72
|
1.336
|
13
|
|
|
>= 73
|
1.362
|
14
|
|
prosthetic endocarditis
|
no
|
0
|
0
|
|
|
yes
|
0.645
|
6
|
|
virulent organism
|
no
|
0
|
0
|
|
|
yes
|
0.903
|
9
|
|
septic shock
|
no
|
0
|
0
|
|
|
yes
|
0.702
|
7
|
|
thrombocytopenia
|
no
|
0
|
0
|
|
|
yes
|
0.655
|
7
|
|
acute renal insufficiency
|
no
|
0
|
0
|
|
|
yes
|
0.542
|
5
|
|
cardiogenic shock
|
no
|
0
|
0
|
|
|
yes
|
1.486
|
15
|
|
periannular complications
|
no
|
0
|
0
|
|
|
yes
|
0.541
|
5
|
where:
• It is uncertain if a patient could have both cardiogenic and septic shock.
X =
= SUM(beta-coefficients) - 3.358
probability of mortality =
= 1 / (1 + EXP((-1) * X))
point score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum point score: 0
• maximum point score: 69
• The higher the point score the greater the risk of mortality.
An estimate for the data in Figure 4:
Y =
= (0.1022 * (point score)) - 3.26
probability =
= 1 / (1 + EXP((-1) * Y))
Performance:
• The area under the ROC curve is 0.80.
