Person:
Fernández Pérez, Cristina

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First Name
Cristina
Last Name
Fernández Pérez
URI
https://hdl.handle.net/20.500.14352/77390
Affiliation
Universidad Complutense de Madrid
Faculty / Institute
Enfermería, Fisioterapia y Podología
Department
Enfermería
Area
Enfermería
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2004 - 200912010 - 20171
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Author: Fernández Pérez, Cristina × Subject: 616.126-002 ×

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    Risk score for cardiac surgery in active left-sided infective endocarditis
    (Risk score for cardiac surgery in active left-sided infective endocarditis, 2017) Olmos, Carmen; Maroto, Luis; Maroto Castellanos, Luis Carlos; Fernández Pérez, Cristina; Vivas Balcones, Luis David; San Román, José Alberto
    Estudio que calcula una escala de riesgo de mortalidad hospitalaria de los pacientes con endocarditis infecciosa a través de la valoración de una cohorte de 1.299 pacientes. A través de las variables edad, situación hemodinámica, insuficiencia renal, microorganismo responsable, complicaciones perianulares o sepsis se puede predecir la probabilidad de muerte hospitalaria ante un paciente ingresado con endocarditis infecciosa. Objective To develop and validate a calculator to predict the risk of in-hospital mortality in patients with active infective endocarditis (IE) undergoing cardiac surgery. Methods Thousand two hundred and ninety-nine consecutive patients with IE were prospectively recruited (1996-2014) and retrospectively analysed. Left-sided patients who underwent cardiac surgery (n=671) form our study population and were randomised into development (n=424) and validation (n=247) samples. Variables statistically significant to predict in-mortality were integrated in a multivariable prediction model, the Risk-Endocarditis Score (RISK-E). The predictive performance of the score and four existing surgical scores (European System for Cardiac Operative Risk Evaluation (EuroSCORE) I and II), Prosthesis, Age ≥70, Large Intracardiac Destruction, Staphylococcus, Urgent Surgery, Sex (Female) (PALSUSE), EuroSCORE ≥10) and Society of Thoracic Surgeons's Infective endocarditis score (STS-IE)) were assessed and compared in our cohort. Finally, an external validation of the RISK-E in a separate population was done. Results Variables included in the final model were age, prosthetic infection, periannular complications, Staphylococcus aureus or fungi infection, acute renal failure, septic shock, cardiogenic shock and thrombocytopaenia. Area under the receiver operating characteristic curve in the validation sample was 0.82 (95% CI 0.75 to 0.88). The accuracy of the other surgical scores when compared with the RISK-E was inferior (p=0.010). Our score also obtained a good predictive performance, area under the curve 0.76 (95% CI 0.64 to 0.88), in the external validation. Conclusions IE-specific factors (microorganisms, periannular complications and sepsis) beside classical variables in heart surgery (age, haemodynamic condition and renal failure) independently predicted perioperative mortality in IE. The RISK-E had better ability to predict surgical mortality in patients with IE when compared with other surgical scores.
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    Hepatosplenic and renal embolisms in infective endocarditis
    (Revista Espanola de Cardiologia, 2004) Luaces Méndez, María; Vilacosta, Isidre; Sarriá, Cristina; Fernández Pérez, Cristina; San Román, José; Sanmartín, Juan; López, Javier; Rodríguez, Enrique
    Introduction and objectives: Among the complications of infective endocarditis, systemic embolisms are an ominous prognostic sign. The aim of the present study was to compare the demographic, clinical, microbiologic and echocardiographic features of episodes of endocarditis accompanied and unaccompanied by embolisms in the spleen, kidney or liver. We also assessed the prognostic impact of these embolisms. Material and method: Prospective, multicenter clinical cohort study. We analyzed 338 consecutive episodes of left-sided infective endocarditis in 308 patients. Episodes were classified in two groups: group I, episodes with hepatosplenic or renal embolisms (n=34); group II, episodes without embolisms (n=304). Results: There were 41 embolisms in 34 episodes (10%). Of these, 34 were located in the spleen, 5 in the kidney and 2 in the liver. Some forms of clinical presentation predominated in group I, e.g., abdominal pain, splenomegaly, cutaneous stigmata, hematuria, embolisms in other locations, and septic shock. Staphylococcus aureus and enterococci were more commonly isolated in group I. Detection of vegetations (by transesophageal echocardiography) was more frequent in group I, and they were larger than vegetations in group II. Hepatosplenic and renal embolisms were not independently associated with the need for cardiac surgery or death. Conclusions: Hepatosplenic and renal embolisms occur in 10% of left-sided episodes of infective endocarditis. The clinical presentation of these episodes has characteristic features. Vegetations are larger than in episodes without these embolism. Hepatosplenic and renal embolisms do not increase neither the need of cardiac surgery nor the risk of death.