External Validation of EuroSCORE I and II in Patients With Infective Endocarditis: Results From a Nationwide Prospective Registry

In this study, the authors aimed to externally validate EuroSCORE I and II in patients surgically treated for infective endocarditis. Furthermore, the authors assessed the predictive performance of both models across sex, redo surgery, age, and urgency. Data from the Netherlands Heart Registration was analyzed, including 2,569 patients with infective endocarditis who underwent cardiac surgery between 2013 and 2021. The overall postoperative 30-day mortality in this cohort was 10.2 percent. The area under the curve was 0.73 for EuroSCORE I and 0.72 for EuroSCORE II. Both models overpredicted postoperative 30-day mortality, with observed-to-expected ratios of 0.37 and 0.69. EuroSCORE I overpredicted mortality across the full range, whereas EuroSCORE II overpredicted mortality only for predicted probabilities above 20 percent. The authors did not observe significant differences in predictive performance across sex, redo surgery, or age. The discriminative capacity of EuroSCORE II was poor in emergency surgeries. Based on their findings, the authors concluded that EuroSCORE I consistently overestimates mortality and should, therefore, not be utilized in endocarditis patients. EuroSCORE II can be used for infective endocarditis patients up to a predicted probability of approximately 20 percent, regardless of sex, redo surgery, or age. For predictive probabilities above 20 percent, the mortality risk should be halved to approach the true mortality risk. EuroSCORE II should not be used for risk prediction in emergency endocarditis surgeries.