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Estimación de la mortalidad quirúrgica de la endocarditis infecciosa: comparación de las diferentes escalas específicas de cálculo de riesgo
Estimation of the risk of mortality after surgery in infective endocarditis: Comparison among specific risk scores
Laura Varelaa,
Autor para correspondencia
lauravarela21089@gmail.com

Autor para correspondencia.
, Laura Vidala, Borja M. Fernández-Felixb, Guillermo Ventosaa, Enrique Navasc, Irene Hidalgoa, Jorge Rodríguez-Rodad, José I. Sáez de Ibarraa, José López-Menéndezd
a Servicio de Cirugía Cardiaca, Hospital Universitario Son Espases, Palma de Mallorca, España
b Unidad de Bioestadística clínica. CIBER Epidemiología y Salud Pública (CIBERESP). Instituto de investigación Hospital Ramón y Cajal (IRYCIS), Madrid, España
c Servicio de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Ramón y Cajal, Madrid, España
d Servicio de Cirugía Cardiovascular, Hospital Universitario Ramón y Cajal, Madrid, España
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el EuroSCORE<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a>&#44; la escala m&#225;s empleada en Europa&#44; y el <span class="elsevierStyleItalic">Society of Thoracic Surgeons&#44; Predicted risk of mortality</span> &#40;STS PROM&#41;&#44; que tiene amplia difusi&#243;n en Estados Unidos<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a>&#46; A pesar de que el EuroSCORE<span class="elsevierStyleHsp" style=""></span>II&#44; creado tras una modificaci&#243;n del EuroSCORE&#44; es la escala utilizada de manera rutinaria en cirug&#237;a cardiaca en nuestro medio&#44; ha demostrado una baja capacidad predictiva en el caso de endocarditis infecciosa &#40;EI&#41; activa<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">3-5</span></a>&#46; La EI constituye una patolog&#237;a con caracter&#237;sticas espec&#237;ficas en la que influyen en la mortalidad algunas variables no calculadas por las ER cl&#225;sicas&#46; Tanto en el caso del EuroSCORE<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">3&#44;6&#44;7</span></a> como en el caso del STS score se demostr&#243; la no utilidad en la predicci&#243;n del riesgo de mortalidad en EI<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">5&#44;8</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Por lo tanto&#44; la incertidumbre en el riesgo quir&#250;rgico que presentan los pacientes con EI ha generado en las &#250;ltimas d&#233;cadas la creaci&#243;n de otras escalas que incluyen diferentes variables espec&#237;ficas de esta entidad &#40;como la presencia de abscesos&#44; la sepsis&#44; el microorganismo causal&#8230;&#41; que han demostrado ser factores independientes de riesgo&#46; En la actualidad existen numerosas escalas de estimaci&#243;n de riesgo espec&#237;ficas de endocarditis infecciosa &#40;EEREI&#41;&#44; y algunas de ellas han demostrado una mejor predicci&#243;n de riesgo en comparaci&#243;n con las escalas de riesgo cl&#225;sicas<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Sin embargo&#44; a pesar del gran n&#250;mero de EEREI disponibles&#44; pocas de ellas han sido validadas de forma externa y ninguna ha demostrado un beneficio claro frente a las dem&#225;s&#46; Hasta la fecha&#44; se han desarrollado pocos estudios de comparaci&#243;n entre diferentes EEREI<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">9&#44;10</span></a>&#44; y por lo tanto no existen claras recomendaciones sobre cu&#225;l de ellas emplear o la validez de la informaci&#243;n que proporcionan&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En el presente trabajo nos proponemos analizar la capacidad predictiva de 10<span class="elsevierStyleHsp" style=""></span>EEREI publicadas previamente para poder establecer recomendaciones respecto de cu&#225;les deber&#237;an emplearse en nuestro medio&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Objetivos del estudio</span><p id="par0030" class="elsevierStylePara elsevierViewall">Como objetivos primarios del estudio se estableci&#243;&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Analizar la precisi&#243;n de la estimaci&#243;n num&#233;rica de mortalidad obtenida por cada escala&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Analizar la capacidad de predicci&#243;n de mortalidad de las diferentes EEREI publicadas&#46;</p></li></ul></p><p id="par0045" class="elsevierStylePara elsevierViewall">Como objetivos secundarios del estudio&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">1&#46;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Comparar la capacidad predictiva de las EEREI analizadas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">2&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Realizar una validaci&#243;n externa de las EEREI&#46;</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Material y m&#233;todos</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Dise&#241;o del estudio</span><p id="par0060" class="elsevierStylePara elsevierViewall">Estudio retrospectivo&#44; observacional&#44; unic&#233;ntrico&#44; que incluy&#243; a todos los pacientes intervenidos de cirug&#237;a cardiaca con diagn&#243;stico de EI aguda&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Poblaci&#243;n a estudio</span><p id="par0065" class="elsevierStylePara elsevierViewall">El estudio incluy&#243; a todos los pacientes intervenidos desde el a&#241;o 2002 al 2017 de forma consecutiva con diagn&#243;stico de EI activa seg&#250;n los criterios de Duke modificados<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">11</span></a>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Variables a estudio</span><p id="par0070" class="elsevierStylePara elsevierViewall">Las variables analizadas fueron recogidas de manera retrospectiva&#44; recopil&#225;ndose de las tres bases de datos del Hospital&#58; SICCS &#40;Sistema Inform&#225;tico Cirug&#237;a Card&#237;aca Sorin&#41; &#40;Biomenco&#44; Madrid&#44; Espa&#241;a&#41;&#44; HORUS y CAJAL &#40;Aplicaci&#243;n de informes cl&#237;nicos V11&#46;1&#41;&#46; Se incluyeron todas las variables necesarias para el c&#225;lculo de las EEREI&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Definici&#243;n de las variables</span><p id="par0075" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">1&#46;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Mortalidad perioperatoria&#58; mortalidad tanto intraoperatoria como postoperatoria durante el ingreso del paciente&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">2&#46;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Endocarditis infecciosa activa&#58; cuadro cl&#237;nico de menos de un mes de evoluci&#243;n&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">3&#46;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Escalas de riesgo cl&#225;sicas&#58; nos referimos a escalas cl&#225;sicas como las no espec&#237;ficas de endocarditis infecciosa&#44; entre las que podemos encontrar el EuroSCORE y el STS score&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">4&#46;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Shock s&#233;ptico&#58; se define por la presencia de hipoperfusi&#243;n e hipoxia tisular en el contexto de un s&#237;ndrome de respuesta inflamatoria sist&#233;mica a un agente infeccioso&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">5&#46;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Trombocitopenia prequir&#250;rgica&#58; recuento plaquetario &#60;<span class="elsevierStyleHsp" style=""></span>150&#46;000 plaquetas&#47;mm<span class="elsevierStyleSup">3</span><a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">6&#46;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Absceso paravalvular&#58; infecci&#243;n y necrosis del tejido adyacente al anillo paravalvular&#44; con formaci&#243;n de una cavidad purulenta con capacidad de invadir estructuras cercanas<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">7&#46;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Tasa de embolia&#58; presencia de embolias sist&#233;micas diagnosticadas mediante datos cl&#237;nicos y pruebas complementarias&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">8&#46;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Cirug&#237;a urgente&#58; intervenci&#243;n quir&#250;rgica que no se puede demorar m&#225;s de 24-48<span class="elsevierStyleHsp" style=""></span>h&#46;</p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">An&#225;lisis estad&#237;stico</span><p id="par0120" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se llev&#243; a cabo empleando Stata&#47;IC 14&#46;2 &#40;Stata Statistical Software&#58; Release 14&#46; College Station&#44; TX&#58; StataCorp LP&#41;&#46; Las variables continuas se expresaron como media y desviaci&#243;n est&#225;ndar &#40;DE&#41;&#46; Las variables categ&#243;ricas se expresaron como frecuencia y proporciones&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Se realiz&#243; la estimaci&#243;n de par&#225;metros poblacionales derivados a partir de los resultados de mortalidad observados en nuestra muestra&#44; mediante estimaci&#243;n de intervalos de confianza de proporciones&#44; expresados como IC del 95&#37;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La valoraci&#243;n de la discriminaci&#243;n de las ER se realiz&#243; mediante el c&#225;lculo del &#225;rea bajo la curva ROC &#40;AUC&#41;&#44; expresada con su valor y su IC del 95&#37;&#46; La calibraci&#243;n se valor&#243; mediante la prueba de Hosmer-Lemeshow&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Consideraciones &#233;ticas</span><p id="par0135" class="elsevierStylePara elsevierViewall">El Comit&#233; &#201;tico de Investigaci&#243;n Cl&#237;nica &#40;CEIC&#41; aprob&#243; la realizaci&#243;n del presente estudio &#40;n&#250;mero de CEIC 313&#47;2016&#44; aprobado el 28 de noviembre de 2016&#41;&#46; No se exigi&#243; consentimiento informado por escrito de los pacientes&#46; La identificaci&#243;n del paciente fue codificada&#44; cumpliendo con los requisitos de la Ley Org&#225;nica de Protecci&#243;n de Datos 15&#47;1999&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Resultados</span><p id="par0140" class="elsevierStylePara elsevierViewall">Durante el periodo de estudio fueron intervenidos 180 pacientes de EI activa en nuestro centro&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> muestra las caracter&#237;sticas basales de los pacientes intervenidos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">De las intervenciones realizadas&#44; en el 32&#44;6&#37; fue sustituci&#243;n valvular a&#243;rtica aislada&#44; en el 30&#44;9&#37; mitral y en el 20&#44;8&#37; de ambas v&#225;lvulas&#44; siendo en el 15&#44;7&#37; restante otras t&#233;cnicas quir&#250;rgicas&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La mortalidad en el postoperatorio inmediato observada en nuestra muestra fue del 26&#44;82&#37; &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 20&#44;74-33&#44;57&#37;&#41;&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Caracter&#237;sticas de las EEREI</span><p id="par0155" class="elsevierStylePara elsevierViewall">Se analizaron un total de 10 EEREI&#44; que incluyeron diferentes variables como factores independientes de mortalidad&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Las EEREI incluidas fueron&#58; STS-IE<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a>&#44; De Feo-Cotrufo<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a>&#44; PALSUSE<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a>&#44; la escala de Costa<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a>&#44; RISK-E score<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a>&#44; AEPEI score<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#44; EndoScore<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#44; SpecificEuroSCORE<span class="elsevierStyleHsp" style=""></span>I y<span class="elsevierStyleHsp" style=""></span>II<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a> y APORTEI<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Las variables incluidas en cada una de las 10 EEREI&#44; al igual que la puntuaci&#243;n asignada a cada variable en cada una de las escalas&#44; puede observarse en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Mortalidad estimada</span><p id="par0170" class="elsevierStylePara elsevierViewall">La mortalidad estimada por las EEREI result&#243; fuera del intervalo de confianza del 95&#37; de la mortalidad observada &#40;20&#44;74 a 33&#44;57&#37;&#41; en 5 de las 10 EEREI&#58; STS-EI&#44; De Feo y AEPEI&#44; las escalas de Costa y EndoScore&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">La mortalidad estimada por cada una de las EEREI fue&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">1&#41;</span><p id="par0180" class="elsevierStylePara elsevierViewall">STS-IE score<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a>&#58; estima una mortalidad entre el 5 y el 20&#37;&#44; siendo la media de puntos obtenida 29&#44;94&#46; Conviene destacar que no es posible calcular la mortalidad en afectaci&#243;n mitro-a&#243;rtica&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">2&#41;</span><p id="par0185" class="elsevierStylePara elsevierViewall">Escala de De Feo-Cotrufo<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a>&#58; media de puntos obtenida 19&#44;73&#44; con una mortalidad estimada entre el 7 y el 17&#37;&#46; Adem&#225;s&#44; la escala de De Feo-Cotrufo solamente es aplicable a EI sobre v&#225;lvula nativa&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">3&#41;</span><p id="par0190" class="elsevierStylePara elsevierViewall">PALSUSE<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a>&#58; media de puntos 2&#44;5&#44; lo que se corresponde con una mortalidad entre el 15 y el 30&#37;&#44; dado que&#44; seg&#250;n los autores&#44; 2 puntos corresponder&#237;an a una mortalidad del 15&#37; y 3 puntos&#44; del 30&#37;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">4&#41;</span><p id="par0195" class="elsevierStylePara elsevierViewall">Escala de Costa<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a>&#58; predice una mortalidad media del 78&#44;9&#37; para una puntuaci&#243;n media de 20&#44;29 puntos&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">5&#41;</span><p id="par0200" class="elsevierStylePara elsevierViewall">RISK-E score<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a>&#58; media de puntos obtenida 24&#44;15&#44; lo que se corresponde con una mortalidad de hasta el 30&#37;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">6&#41;</span><p id="par0205" class="elsevierStylePara elsevierViewall">AEPEI score<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#58; mortalidad estimada entre el 14&#44;1 y el 18&#44;9&#37; para una media de puntos de 2&#44;42&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">7&#41;</span><p id="par0210" class="elsevierStylePara elsevierViewall">EndoScore<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#58; media de puntos 0&#44;14 en su modelo de predicci&#243;n log&#237;stico&#44; lo que se corresponde con un 46&#44;5&#37; de mortalidad&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">8&#41;</span><p id="par0215" class="elsevierStylePara elsevierViewall">SpecificEuroSCORE<span class="elsevierStyleHsp" style=""></span>I y<span class="elsevierStyleHsp" style=""></span>II<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a>&#58; se obtuvo una media de puntos de 149&#44;8 y 124&#44;3&#44; respectivamente&#44; lo que se corresponde en ambos casos con una mortalidad observada entre el 30 y el 40&#37;</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">9&#41;</span><p id="par0220" class="elsevierStylePara elsevierViewall">APORTEI<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a>&#58; Obtuvo una media de puntos de 70&#44; lo que se corresponde con una mortalidad estimada entre el 20 y el 40&#37;&#46;</p></li></ul></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discriminaci&#243;n y calibraci&#243;n</span><p id="par0225" class="elsevierStylePara elsevierViewall">La discriminaci&#243;n y la calibraci&#243;n de las 10 EEREI se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0230" class="elsevierStylePara elsevierViewall">Se puede observar que tanto la discriminaci&#243;n como la calibraci&#243;n fueron &#243;ptimas para las EEREI analizadas&#44; salvo en los casos de la escala de Costa&#44; que present&#243; una baja discriminaci&#243;n &#40;AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;65&#44; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;57-0&#44;72&#41;&#44; y AEPEI&#44; donde la calibraci&#243;n fue sub&#243;ptima &#40;HLt p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#41;&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">La discriminaci&#243;n de las 10 EEREI se compar&#243; gr&#225;ficamente en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Discusi&#243;n</span><p id="par0240" class="elsevierStylePara elsevierViewall">La EI representa una patolog&#237;a grave con una elevada mortalidad&#44; estimada entre el 9 y el 26&#37;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">22-24</span></a>&#46; La gran variabilidad en el pron&#243;stico se debe en gran medida a la presencia de factores influyentes en el riesgo quir&#250;rgico&#44; como las comorbilidades de los pacientes&#44; la variabilidad de la respuesta antibi&#243;tica&#44; la etiolog&#237;a&#44; la presentaci&#243;n cl&#237;nica&#8230;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">25</span></a>&#46; Adem&#225;s de los que podemos considerar factores generales&#44; en EI se conoce de la existencia de lo que llamamos factores de riesgo espec&#237;ficos de EI &#40;abscesos paravalvulares&#44; vegetaciones&#44; dehiscencia prot&#233;sica&#44; embolia&#8230;&#41; o factores independientes de mortalidad&#44; que pueden ser fundamentales a la hora de establecer el riesgo<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">La cirug&#237;a cardiaca es el tratamiento de elecci&#243;n en aproximadamente el 20-50&#37; de los casos&#44; pero asocia un alto riesgo por su elevada complejidad&#46; Las indicaciones de llevar a cabo tratamiento quir&#250;rgico se establecen en las Gu&#237;as de pr&#225;ctica cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a>&#46; Sin embargo&#44; se estima que un alto porcentaje de pacientes con indicaci&#243;n de cirug&#237;a seg&#250;n las gu&#237;as cl&#237;nicas no son finalmente intervenidos<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">27</span></a>&#46; Una de las posibles explicaciones es el elevado riesgo asociado a la intervenci&#243;n quir&#250;rgica<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">28</span></a> y la gran dificultad t&#233;cnica que pueden suponer este tipo de cirug&#237;as&#46; En cambio&#44; los pacientes con indicaci&#243;n de cirug&#237;a que no son finalmente sometidos a procedimiento quir&#250;rgico presentan un pron&#243;stico infausto<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a>&#46; Por el contrario&#44; los estudios realizados en pacientes sometidos a intervenci&#243;n quir&#250;rgica han objetivado una mortalidad a largo plazo aceptable<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> una vez superado el postoperatorio inmediato&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">En este escenario&#44; valorar el riesgo-beneficio de la cirug&#237;a se ha convertido en el objetivo de numerosos estudios&#44; ya que la correcta estimaci&#243;n del riesgo ayuda en la decisi&#243;n terap&#233;utica en los equipos multidisciplinares y supone una gu&#237;a en la informaci&#243;n facilitada a los pacientes y a sus familiares&#46; La preocupaci&#243;n general de poder objetivar el riesgo quir&#250;rgico se puede observar en la creaci&#243;n de m&#250;ltiples EEREI en los &#250;ltimos a&#241;os&#46; Realizar la validaci&#243;n externa de estas EEREI&#44; adem&#225;s de comprar su capacidad de predicci&#243;n pron&#243;stica&#44; fueron los objetivos del presente estudio&#44; ya que muchas de las EEREI publicadas solamente disponen de validaci&#243;n interna&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">De forma generalizada&#44; las EEREI mejoran la capacidad pron&#243;stica en comparaci&#243;n con los ER cl&#225;sicos<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">3&#44;5</span></a> &#40;EuroSCORE y STS&#41; por la inclusi&#243;n en su c&#225;lculo de factores espec&#237;ficos de EI anteriormente mencionados&#46; Entre las diferentes EEREI desarrolladas hemos analizado&#58;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">1&#41;</span><p id="par0260" class="elsevierStylePara elsevierViewall">La adaptaci&#243;n de la escala STS&#44; la STS-EI&#46; Al igual que en nuestra muestra&#44; ha demostrado una buena predicci&#243;n de mortalidad tras validaciones externas<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">5&#44;9</span></a>&#44; pero presenta el inconveniente de no ser aplicable en el caso de afectaci&#243;n multivalvular&#44; lo que en nuestro caso supone el 26&#37; de la muestra&#46;</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">2&#41;</span><p id="par0265" class="elsevierStylePara elsevierViewall">La escala de De Feo-Cotrufo&#44; exclusiva de EI sobre v&#225;lvula nativa<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a> y que en la actualidad es la &#250;nica que se incluye en las Nuevas Gu&#237;as de la EACTS<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a>&#44; demostr&#243; una infraestimaci&#243;n de la mortalidad en este trabajo&#46;</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">3&#41;</span><p id="par0270" class="elsevierStylePara elsevierViewall">PALSUSE<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a>&#44; con un c&#225;lculo sencillo e intuitivo&#44; incorpora la escala cl&#225;sica EuroSCORE como una de las variables&#46;</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">4&#41;</span><p id="par0275" class="elsevierStylePara elsevierViewall">La escala de Costa<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a>&#44; que en nuestra muestra present&#243; una baja discriminaci&#243;n &#40;AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;65&#44; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;57-0&#44;72&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">5&#41;</span><p id="par0280" class="elsevierStylePara elsevierViewall">RISK-E score<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a>&#58; incorpora varios factores no incluidos previamente en el c&#225;lculo de riesgo en EI&#44; como la trombocitopenia<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">12&#44;31</span></a> y el shock s&#233;ptico<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">6&#41;</span><p id="par0285" class="elsevierStylePara elsevierViewall">AEPEI score<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#58; incluye variables no espec&#237;ficas de EI y aporta el beneficio de un c&#225;lculo sencillo&#44; pero en nuestra muestra present&#243; una mala calibraci&#243;n de la estimaci&#243;n de la mortalidad &#40;HLt p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">7&#41;</span><p id="par0290" class="elsevierStylePara elsevierViewall">EndoScore<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#58; modelo de predicci&#243;n log&#237;stico con un c&#225;lculo complicado y que demostr&#243; una sobreestimaci&#243;n de la mortalidad en nuestra muestra&#46;</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">8&#41;</span><p id="par0295" class="elsevierStylePara elsevierViewall">SpecificEuroSCORE<span class="elsevierStyleHsp" style=""></span>I y<span class="elsevierStyleHsp" style=""></span>II<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a>&#58; modificaciones de la escala cl&#225;sica EuroSCORE para hacerla espec&#237;fica de EI&#46;</p></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">9&#41;</span><p id="par0300" class="elsevierStylePara elsevierViewall">APORTEI<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a>&#44; desarrollada tras una revisi&#243;n sistem&#225;tica y metaan&#225;lisis<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a>&#58; al contrario de lo que ocurre con otras de las anteriormente mencionadas EEREI&#44; APORTEI fue validada en la cohorte nacional GAMES&#44; tras lo cual se cre&#243; una calculadora para facilitar su uso en la pr&#225;ctica cl&#237;nica habitual&#46;</p></li></ul></p><p id="par0305" class="elsevierStylePara elsevierViewall">Adem&#225;s de las EEREI analizadas&#44; debemos destacar otras propuestas recientes que no se adaptaron a la poblaci&#243;n de nuestro estudio&#46; Entre ellas destacan el ICE score<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a>&#44; creado para estimar la mortalidad a los 6<span class="elsevierStyleHsp" style=""></span>meses en pacientes con tratamiento tanto quir&#250;rgico como antibi&#243;tico&#59; el ACEF score<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">34</span></a>&#44; una combinaci&#243;n de 3 variables como predictor de mortalidad tanto en el postoperatorio inmediato como a largo plazo y tambi&#233;n desarrollado incluyendo pacientes no operados&#44; y ANCLA score<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">35</span></a>&#44; desarrollado a partir de un estudio unic&#233;ntrico retrospectivo que combina 5 variables&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">Como se ha mencionado previamente&#44; los par&#225;metros incluidos en cada una de las EEREI no son uniformes &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#44; lo que hace dif&#237;cil decantarse por un sistema de predicci&#243;n del riesgo<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a>&#46; Observamos que el estado preoperatorio cr&#237;tico&#44; la cirug&#237;a de emergencia y el shock card&#237;aco son predictores casi universales de mal pron&#243;stico despu&#233;s de la cirug&#237;a card&#237;aca&#44; y como consecuencia son variables independientes en todas las EEREI&#44; a pesar de que su peso espec&#237;fico difiere en cada una de ellas&#46; Por ejemplo&#44; en PALSUSE<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a> la emergencia es una variable independiente secundaria &#40;incluida en el EuroSCORE&#44; que es a su vez un factor de puntuaci&#243;n&#41;&#44; mientras que en otras EEREI cobra mayor valor&#46; Por otro lado&#44; en el STS-IE<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a>&#44; en APORTEI<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a> y en De Feo-Cotrufo<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a> la condici&#243;n hemodin&#225;mica preoperatoria es el mayor predictor de mortalidad&#46; La presencia de abscesos y destrucci&#243;n intracardiaca no est&#225;n presentes en STS-IE ni AEPEI<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#44; pero s&#237; en el resto de EEREI&#46; La presencia de EI prot&#233;sica es considerada factor de mal pron&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">36&#44;37</span></a> pero no es aplicable a la escala de De Feo-Cotrufo&#44; que solo incluye EI nativa&#46; Y la trombocitopenia y el shock s&#233;ptico cobran especial relevancia en el RISK-E<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">La informaci&#243;n sobre el comportamiento de la EI constituye una herramienta fundamental en la toma de decisiones terap&#233;uticas&#46; La validaci&#243;n externa de las EEREI previamente publicadas y su comparaci&#243;n a la hora de predecir la mortalidad pueden proporcionar informaci&#243;n relevante y ayudar en la valoraci&#243;n del tratamiento quir&#250;rgico&#46; Tras su estudio en nuestra muestra&#44; observamos diferencias en la precisi&#243;n de la estimaci&#243;n de mortalidad de las diferentes EEREI&#46; PALSUSE&#44; RISK-E&#44; SpecificEuroSCORE<span class="elsevierStyleHsp" style=""></span>I y<span class="elsevierStyleHsp" style=""></span>II y APORTEI demostraron superioridad frente al resto de EEREI en la predicci&#243;n de mortalidad&#46;</p><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Limitaciones</span><p id="par0320" class="elsevierStylePara elsevierViewall">Es necesario tener en cuenta el limitado tama&#241;o muestral&#44; que solamente incluy&#243; 180 pacientes&#44; y que se trata de un estudio unic&#233;ntrico y retrospectivo con sus consiguientes limitaciones a la hora de obtener conclusiones&#46; Al mismo tiempo&#44; se trata de un periodo de tiempo prolongado para el limitado n&#250;mero de intervenciones&#46; La mortalidad global reportada en el estudio es superior a la documentada en la base de datos nacional &#40;cohorte GAMES&#41;&#44; que en el periodo 2008-2018 fue del 22&#44;8&#37;&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">Las EEREI analizadas presentan importantes diferencias en cuanto a factores incluidos&#44; m&#233;todo de c&#225;lculo&#44; estudios de los que derivan&#44; poblaci&#243;n diana&#8230;&#44; por lo que los datos resultantes deben analizarse con precauci&#243;n&#46; El desarrollo de estudios prospectivos multic&#233;ntricos que analicen las diferencias entre las diferentes EEREI podr&#237;a aportar informaci&#243;n relativa al pron&#243;stico y profundizar en el estudio de la EI&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">Al mismo tiempo&#44; al tratarse el presente trabajo de un estudio unic&#233;ntrico&#44; con un n&#250;mero limitado de pacientes&#44; creemos que nuevos an&#225;lisis sobre las diferentes escalas creadas podr&#237;an ofrecer m&#225;s datos en cuento a su utilidad en diferentes poblaciones&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conclusiones</span><p id="par0335" class="elsevierStylePara elsevierViewall">De las 10 EEREI analizadas&#44; PALSUSE&#44; RISK-E&#44; SpecificEuroSCORE<span class="elsevierStyleHsp" style=""></span>I y<span class="elsevierStyleHsp" style=""></span>II y APORTEI demostraron una predicci&#243;n de mortalidad precisa y una adecuada capacidad predictiva en el postoperatorio inmediato de cirug&#237;a cardiaca por endocarditis infecciosa&#46;</p><p id="par0340" class="elsevierStylePara elsevierViewall">PALSUSE demostr&#243; una mortalidad predicha media de 15-30&#37;&#44; AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;68 &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;58-0&#44;76&#41; y HLt p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;46&#59; RISK-E score estim&#243; un mortalidad entre 0 y 30&#37;&#44; AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;76 &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;69-0&#44;82&#41; y HLt p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;35&#59; SpecificEuroSCORE<span class="elsevierStyleHsp" style=""></span>I y<span class="elsevierStyleHsp" style=""></span>II mostraron una mortalidad estimada del 30-40&#37; y presentaron AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;76 &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;69-0&#44;82&#41; y HLt p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span> 0&#44;42 en el caso de SpecificEuroSCORE<span class="elsevierStyleHsp" style=""></span>I y AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;74 &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;66-0&#44;79&#41; con HLt<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;75 en el caso de SpecificEuroSCORE<span class="elsevierStyleHsp" style=""></span>II&#44; y APORTEI estim&#243; una mortalidad del 20-40&#37;&#44; AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;75 &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;68-0&#44;82&#41; y HLt p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;73&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Financiaci&#243;n</span><p id="par0345" class="elsevierStylePara elsevierViewall">No ha habido financiaci&#243;n de ning&#250;n tipo&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflicto de intereses</span><p id="par0350" class="elsevierStylePara elsevierViewall">No existe conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En la actualidad no existe ninguna comparaci&#243;n de la capacidad predictiva de las diferentes escalas espec&#237;ficas de riesgo quir&#250;rgico en endocarditis infecciosa&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Comparar la utilidad de las diferentes escalas espec&#237;ficas publicadas&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; retrospectivo y unic&#233;ntrico&#46; Se incluyeron 180 pacientes&#44; en los que se calcularon 10 escalas&#46; Se calcul&#243; la mortalidad estimada por cada escala y se compar&#243; con la mortalidad observada&#44; con su estimaci&#243;n a trav&#233;s del intervalo de confianza del 95&#37;&#46; Se valor&#243; la discriminaci&#243;n&#44; por el &#225;rea bajo la curva ROC &#40;AUC&#41;&#44; y la calibraci&#243;n con el test de Homer-Lemeshow &#40;HLt&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La mortalidad observada fue del 26&#44;82&#37; &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 20&#44;74-33&#44;57&#37;&#41;&#46; Las escalas STS-EI&#44; De Feo y AEPEI infraestimaron la mortalidad&#59; las escalas de Costa y Endoscore la sobreestimaron&#46; La escala de Costa present&#243; una baja discriminaci&#243;n y AEPEI demostr&#243; una calibraci&#243;n sub&#243;ptima&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En nuestra serie&#44; las escalas que demostraron una estimaci&#243;n precisa fueron&#58; 1&#41;<span class="elsevierStyleHsp" style=""></span>PALSUSE&#58; mortalidad predicha 15-30&#37;&#44; AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;68 &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;58-0&#44;76&#41; y HLt p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;46&#59; 2&#41;<span class="elsevierStyleHsp" style=""></span>RISK-E score&#58; estima mortalidad 0-30&#37;&#44; AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;76 &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;69-0&#44;82&#41; y HLt p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;35&#59; 3&#41;<span class="elsevierStyleHsp" style=""></span>SpecificEuroSCORES<span class="elsevierStyleHsp" style=""></span>I y<span class="elsevierStyleHsp" style=""></span>II&#58; mortalidad estimada 30-40&#37;&#44; AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;76 &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;69-0&#44;82&#41; y HLt p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;42 en<span class="elsevierStyleHsp" style=""></span>I y AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;74 &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;66-0&#44;79&#41; con HLt<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;75 en<span class="elsevierStyleHsp" style=""></span>II&#59; 4&#41; APORTEI&#58; predice mortalidad de 20-40&#37;&#44; AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;75 &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;68-0&#44;82&#41; y HLt p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;73&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">De las 10 escalas analizadas&#44; PALSUSE&#44; RISK-E&#44; SpecificEuroSCORE y APORTEI demostraron una predicci&#243;n de mortalidad precisa y una adecuada capacidad predictiva en el postoperatorio inmediato de cirug&#237;a cardiaca por endocarditis infecciosa&#46;</p></span>"
        "secciones" => array:5 [
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            "titulo" => "Introducci&#243;n"
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            "titulo" => "Objetivo"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Material y m&#233;todos"
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            "titulo" => "Resultados"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A direct comparison among specific endocarditis risk scores has not yet been conducted&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Compare the previously published endocarditis specific scores and analyze their prognostic accuracy&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material and methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We performed an observational single-center and retrospective study&#46; 180 patients were included&#44; and 10 specific risk scores were calculated&#46; Estimated mortality was calculated for each score and it was compared with the observed mortality&#44; with its 95&#37; confidence interval estimation&#46; Discrimination was assessed by area under the ROC curve &#40;AUC&#41; and calibration was assessed by Homer-Lemeshow test &#40;HLt&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Observed surgical mortality was 26&#46;82&#37; &#40;95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 20&#46;74-33&#46;57&#41;&#46; STS-EI&#44; De Feo and AEPEI scores underestimated mortality&#44; whereas Costa score and Endoscore overestimated mortality&#46; Costa score demonstrated a low discrimination &#40;AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;65&#44; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI 0&#46;57-0&#46;72&#41; and AEPEI showed a suboptimal calibration &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;025&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">showed an accurate estimated mortality in&#58; 1&#41;<span class="elsevierStyleHsp" style=""></span>PALSUSE showed predicted mortality to be between 15-30&#37;&#44; AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;68 &#40;95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 0&#46;58-0&#46;76&#41; and HLt <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;46&#59; 2&#41;<span class="elsevierStyleHsp" style=""></span>RISK-E score estimated a mortality of 0-30&#37;&#44; AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;76 &#40;95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 0&#46;69-0&#46;82&#41; and HLt <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;35&#59; 3&#41;<span class="elsevierStyleHsp" style=""></span>SpecificEuroSCORES<span class="elsevierStyleHsp" style=""></span>I y<span class="elsevierStyleHsp" style=""></span>II with an estimated mortality of 30-40&#37;&#44; AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;76 &#40;95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 0&#44;69-0&#44;82&#41; y HLt <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;42 for SpecificEuroSCORES I and AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;74 &#40;95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 0&#44;66-0&#44;79&#41; con HLt<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;75 in SpecificEuroSCORES II&#59; 4&#41;<span class="elsevierStyleHsp" style=""></span>APORTEI showed predicted mortality to be between 20 and 40&#37;&#44; with AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;75 &#40;95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 0&#46;68-0&#46;82&#41; and HLt <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;73&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusion</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Among the 10 assessed endocarditis specific scores scores&#44; PALSUSE&#44; RISK-E&#44; SpecificEuroSCORE and APORTEI demonstrated an optimal mortality risk estimation and an adequate predictive capacity for postoperative mortality in the postoperative period after cardiac surgery for infective endocarditis&#46;</p></span>"
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            "identificador" => "abst0040"
            "titulo" => "Material and methods"
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            "identificador" => "abst0045"
            "titulo" => "Results"
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          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Results"
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          5 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "Conclusion"
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de la discriminaci&#243;n en las 10 escalas espec&#237;ficas de endocarditis&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total muestra &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>180&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad &#40;a&#241;os&#41;&#44; media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44;3 &#40;13&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo var&#243;n&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121 &#40;67&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factores de riesgo cardiovascular</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertensi&#243;n arterial&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94 &#40;52&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipemia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;38&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes mellitus&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;18&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EPOC&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;14&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arteriopat&#237;a perif&#233;rica&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;8&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Insuficiencia renal&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;19&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&#225;lvula afecta</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&#243;rtica&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;36&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mitral&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;36&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mitro-a&#243;rtica&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;26&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&#225;lvula nativa&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113 &#40;62&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pr&#243;tesis valvular&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;37&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Datos ETE</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Insuficiencia valvular severa&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129 &#40;72&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disfunci&#243;n pr&#243;tesis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;27&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vegetaciones&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130 &#40;73&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absceso&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;34&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Microorganismo causal</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S&#46; aureus</span>&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;20&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S&#46; epidermidis</span>&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;25&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Enterococcus</span> spp&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;10&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemocultivos negativos&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="9" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presentaci&#243;n cl&#237;nica</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Embolia sist&#233;mica&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;34&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ACVA&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;22&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Insuficiencia renal&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;14&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NHYA &#62;<span class="elsevierStyleHsp" style=""></span>III&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">132 &#40;74&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FEVI&#44; media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#44;7 &#40;9&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shock&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;22&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ventilaci&#243;n mec&#225;nica preoperatoria&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;10&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ionotr&#243;picos preoperatorios&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;21&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cirug&#237;a urgente&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93 &#40;51&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">BAV&#58; bloqueo auriculoventricular&#59; BCIa&#58; bal&#243;n de contrapulsaci&#243;n intraa&#243;rtico&#59; DM&#58; diabetes mellitus&#59; DMID&#58; diabetes mellitus insulinodependiente&#59; DMNID&#58; diabetes mellitus no insulinodependiente&#59; EC&#58; estado cr&#237;tico&#59; EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#59; HTA&#58; hipertensi&#243;n arterial&#59; HTP&#58; hipertensi&#243;n pulmonar&#44; entendida como presi&#243;n arteria pulmonar &#8805;<span class="elsevierStyleHsp" style=""></span>55<span class="elsevierStyleHsp" style=""></span>mmHg&#59; IMC&#58; &#237;ndice de masa corporal&#59; IR&#58; insuficiencia renal considerada como nivel Cr &#8805;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; NYHA&#58; <span class="elsevierStyleItalic">New York Heart Assotiation scale</span>&#59; P&#46;A&#58; <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#59; S&#46;A&#58; <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">STSS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PALSUSE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">De Feo-Cotrufo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Costa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RISK-E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AEPEI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">EndoScore<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Spec&#46;ES 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Spec&#46;ES 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 70&#58; 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40-49&#58; 550-59&#58; 760-69&#58; 970-79&#58; 11&#62; 80&#58; 13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805; 40&#58; 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52-63&#58; 064-72&#58; 13&#8805; 73&#58; 14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60-70&#58; 0&#44;4670-80&#58; 0&#44;88&#62;80&#58; 1&#44;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 60-65&#58; 1165-70&#58; 2270-75&#58; 3375-80&#58; 4480-85&#58; 5685-90&#58; 6790-100&#58; 78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 60-65&#58; 1165-70&#58; 2270-75&#58; 3375-80&#58; 4480-85&#58; 5685-90&#58; 6790-100&#58; 78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo &#40;femenino&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cirug&#237;a urgente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emerg&#58; 30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42Emerg&#58; 70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17BCIa&#58; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EC&#58; 11NYHA IV&#58; 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;5NYHA IV&#58; 1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EC&#58; 42NYHA &#62;<span class="elsevierStyleHsp" style=""></span>I&#58; 26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EC&#58; 37NYHA &#62;<span class="elsevierStyleHsp" style=""></span>I&#58; 22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multival&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#58; 0&#44;53&#58; 1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EI prot&#233;sica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No aplicable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CC previa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#237;stula&#58; 46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">F&#237;stula&#58; 41&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Vegetaciones&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">EuroSCORE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8805; 10&#37;&#58; 1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Trombocitopenia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Otros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EI activa&#58; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">IMC &#62; 27&#58; 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EI mitral&#58; 14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EI mitral&#58; 14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">C&#225;lculo logar&#237;tmico con beta-coeficientes a los que hay que sumar una constante &#8722;2&#44;60 y la fracci&#243;n de eyecci&#243;n del ventr&#237;culo izquierdo &#40;&#37;&#41; x<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Discriminaci&#243;nAUC &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Calibraci&#243;nHLt&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="10" align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">STSS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;76 &#40;0&#44;68-0&#44;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">De Feo-Cotrufo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;68 &#40;0&#44;58-0&#44;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">PALSUSE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;73 &#40;0&#44;66-0&#44;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Costa score&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;65 &#40;0&#44;57-0&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Risk-E score&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;35&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 11340096
Idioma original: Español
DOI:10.1016/j.circv.2020.06.002
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