Women- do they need different guidelines? Sex differences in infective endocarditis: the POL-ENDO substudy (Polish Infective Endocarditis Registry)

Background Infective endocarditis (IE) is associated with high morbidity and mortality. Sex differences in clinical profile and treatment outcomes of IE patients are reported. The impact of sex differences on IE characteristics in Poland has never been described. Aims This study aimed to assess the impact of sex differences on clinical profile and treatment outcomes of IE patients in Poland, through a detailed examination of data sourced from the Polish Infective Endocarditis Registry (POL-ENDO). Methods A prospective multicenter observational cohort study – the POL-ENDO registry – in IE patients from 160 medical centers in Poland registered between August 2022 and December 2024 was conduct. The demographic, clinical and treatment outcome data were assessed. Results Of a total of 1844 IE patients, 513 were female [27.8%]. Female group were older [65.5±17.3 vs. 60.2±15.7, p<0.001]. The aortic valve IE predominated among male group [41.9% vs. 55.4%, p<0.001] contrary to mitral valve IE which prevailed among female gender [38.8% vs. 27.3%, p<0.001]. Anemia as a risk factor was more prominent within female gender [33.7% vs. 28.4%, p=0.029]. Among male group prevailed alcohol abuse [9.5% vs. 2,1%, p<0.001] and nicotinism [16,8% vs. 7,6%, p<0.001]. Coronary artery disease predominated among male group [30.6% vs. 20.6%, p<0.001] followed by congenital heart disease [7% vs. 3,7%, p=0.010]. Dental procedure in last 6 months was observed more often among male group [8,1% vs. 4,4%, p<0.001].Embolic events as inhospital complications predominated within female patients [13.2% vs. 10.3%, OR 1.42, 95% CI 1.02-1.97, p=0.038] followed by vegetation size increasing [5.3% vs. 3.1%, OR 1.90, 95% CI 1.13-3.20, p=0.015]. Nephritis prevailed among female group [2.5% vs. 0.8%, OR 2.78, 95% CI 1.20-6.44, p=0.017]. Female gender was associated with greater inhospital mortality [23% vs. 16.1%, p=0.005] Conclusion The female IE patients were older. The vegetation size increasing, and embolic events predominated in female patients, this has to be subject of further evaluation. Sex may be a significant factor in determining the urgency of cardiac surgery. Female gender was associated with greater inhospital mortality.