Prosthetic valve endocarditis patients had 15.8% in-hospital mortality vs 21.0% in native valve endocarditis, with adjusted HR 0.66 indicating lower mortality risk.
Does prosthetic valve endocarditis have worse in-hospital mortality compared to native valve endocarditis?
In a nationwide Danish cohort, prosthetic valve endocarditis was associated with a lower adjusted risk of in-hospital mortality compared to native valve endocarditis, challenging the assumption that PVE inherently carries worse outcomes.
Absolute Event Rate: 0% vs 0%
Abstract Background Prosthetic valve endocarditis (PVE) is considered a rare and serious complication of valve replacement and worse outcomes have been reported for PVE versus (vs.) native valve endocarditis (NVE) in cohorts from tertiary centres. Complete data on clinical presentation and practice patterns may inform strategies for prevention and optimisation of PVE Purpose The study aimed to examine clinical characteristics, microbiological profile, surgical management, and in-hospital mortality in patients with PVE versus NVE on nationwide scale. Methods The Danish NatIonal enDocarditis stUdieS (NIDUS) registry was used to obtain data on all patients with PVE or NVE from 2016-2021 in Denmark. Patients were classified as having a PVE or NVE according to the modified Duke-criteria. We reported the pre-existing comorbidities, clinical presentation, microbiological etiology and surgical treatment. In-hospital mortality rates for PVE and NVE were assessed using the reversed Kaplan-Maier estimator and adjusted Cox regression models. Results In total 3,017 patients were included, of which 758 (25.1%) had PVE, and 2,259 (74.9%) had NVE. In the PVE group the median age was 76.3 IQR 69.9-81.7, 73.6% were males, while in the NVE group the median age was 72.8 IQR 63.4-80.1, 64.8% were males. The comorbidity burden was similar between the groups. The median length of hospital stay for PVE was 44 days IQR 28.0-52.0, and for NVE 34 days 24.0-45.0. In PVE group 567 (74.8%) had definite IE and 191 (25.2) had possible IE, while in the NVE group 1,863 (82.5%) had definite IE and 396 (17.5) possible IE. At admission, fever (PVE 65.3% vs. NVE 59.8%) and dyspnoea (PVE 36.6% vs. NVE 31.7%) were the most common symptoms. The number of patients who presented with embolism (PVE 10.1% vs. NVE 12.5%) and sepsis at admission were comparable (PVE 24.4% vs. NVE 23.2%). The most common microbiological etiologies in the PVE were Streptococcus spp. (29.9%), S.aureus (22.2%) and Enterococcus spp. (24.4%). The most common microbiological etiologies in the NVE group were Streptococcus spp. (33.7%), S. aureus (33.2%) and Enterococcus spp. (14.4%), Figure 1. In the PVE and NVE group, 177 (23.4%) and 485 (21.5%) underwent surgery during admission (p = 0.3), respectively. The absolute risk of in-hospital mortality for those with PVE was 15.8 % (95% CI 13.2-18.4%), and for NVE 21.0% (95% CI 19.3-22.7%) with an adjusted hazard ratio of 0.66 95% CI 0.54-0.81. Conclusion In this nationwide study, patients with PVE were older, had similar comorbidity burden, and longer length of hospital stay compared to NVE. The PVE group had a higher prevalence of Enterococcus spp. Although PVE is a severe condition, our findings indicate that its outcomes are more comparable to NVE than previously assumed.Figure 1
Hadji-Turdeghal et al. (Sat,) reported a other. Prosthetic valve endocarditis patients had 15.8% in-hospital mortality vs 21.0% in native valve endocarditis, with adjusted HR 0.66 indicating lower mortality risk.