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Superior Predictive Value of the Modified AEPEI Score in Surgical Infective Endocarditis: Insights From an 8-Year Cohort
Session:
Sessão de Posters 24 - Endocardite infeciosa: estratificação de risco, tratamento e desfechos
Speaker:
Rodrigo Neves Brandão
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.8 Infective Endocarditis - Other
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Rodrigo Neves Brandão; Inês Madeira Santos; Luís Cotrim; Tiago Mesquita; Inês Pereira Miranda; Filipa Gerardo; Carolina Mateus; Miguel Santos
Abstract
<p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Background:</strong> Risk stratification in infective endocarditis (IE) remains challenging, particularly in the perioperative setting where early postoperative mortality is substantial. Several prognostic models have been proposed, including IE-specific scores (modified AEPEI, PALSUSE) and classical cardiac surgery scores (logistic EUROSCORE and EUROSCORE II). </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Objetives:</strong> Comparatively evaluate the performance of these four models in predicting early postoperative mortality in patients undergoing surgery for IE, including a stratified analysis for native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE)</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong> Single center, retrospective, observational study including IE patients between January 2017 and October 2025. The modified AEPEI, PALSUSE, logistic EUROSCORE, and EUROSCORE II were calculated for all patients. The primary endpoint was early all-cause mortality (defined as in-hospital mortality or early post-op mortality - death within the first month). Discriminatory ability was assessed using ROC-AUC analysis, and independent predictors were identified through multivariable logistic regression. A stratified analysis was also performed for NVE and PVE.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong> From a total of 183 patients, 55% (n=100) were male and the mean age was 69.5 ±11.9 years. From the latter, 126 had surgical indication. Modified AEPEI score demonstrated the best discriminative performance (AUC 0.715; OR: 2.06; IC 95% [1.36, 3.12]; p<0.001) and was the only independent predictor of early mortality in the multivariable model (OR 2.044; IC 95% [1.32, 3.16]; p=0.001). The PALSUSE score showed moderate discrimination (AUC 0.613; OR: 1.33; IC 95% [1.00, 1.78]; p=0.048). Classical surgical scores performed worse: logistic EUROSCORE (AUC 0.608; OR: 1.01; IC 95% [0.99, 1.03; p=0.016) and EuroSCORE II (AUC 0.610; OR: 1.03; IC 95% [1.00, 1.07]; p=0.047). In NVE, only the modified AEPEI (AUC 0.679; OR.1.80; IC 95% [1.12, 2.88] p=0.014) and PALSUSE (AUC 0.660; OR: 1.71; IC 95% [1.09, 2.68]; p=0.020) remained significant, though with low sensitivity. In PVE, the modified AEPEI score clearly outperformed all others (AUC 0.770; OR: 2.87; IC 95% [1.14, 7.22]; p=0.025) and was the only significant independent predictor in multivariable analysis (p=0.035), whereas PALSUSE and EuroSCOREs offered no discriminative value. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion:</strong> The modified AEPEI score emerged as the strongest and most consistent predictor of early postoperative mortality in patients undergoing surgery for IE, outperforming all other scores both in the overall surgical population and within disease subtypes, particularly in PVE. Curiously, PALSUSE showed mild usefulness confined to NVE. These results reinforce the need for dedicated disease-specific prognostic models in this high-risk population instead of general surgical risk scores. </span></span></p>
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