Key result
Chronic hemodialysis linked to ~92% higher 6-month mortality in infective endocarditis.
Why the study?
Infective endocarditis is a common and serious complication in patients receiving chronic hemodialysis, but differences in complications, surgery, relapses, and mortality compared to non-HD patients were unclear.
Does chronic hemodialysis worsen outcomes in patients with infective endocarditis compared to non-hemodialysis patients?
Cohort (n=6,691)
Yes
Does chronic hemodialysis worsen outcomes in patients with infective endocarditis compared to non-hemodialysis patients?
Absolute Event Rate: 39.8% vs 20.7%
p-value: p=<0.001
Patients on chronic hemodialysis who develop infective endocarditis face significantly higher mortality and relapse rates, yet undergo cardiac surgery less frequently than non-hemodialysis patients.
BACKGROUND Infective endocarditis (IE) is a common and serious complication in patients receiving chronic hemodialysis (HD). OBJECTIVES This study sought to investigate whether there are significant differences in complications, cardiac surgery, relapses, and mortality between IE cases in HD and non-HD patients. METHODS Prospective cohort study (International Collaboration on Endocarditis databases, encompassing 7,715 IE episodes from 2000 to 2006 and from 2008 to 2012). Descriptive analysis of baseline characteristics, epidemiological and etiological features, complications and outcomes, and their comparison between HD and non-HD patients was performed. Risk factors for major embolic events, cardiac surgery, relapses, and in-hospital and 6-month mortality were investigated in HD-patients using multivariable logistic regression. RESULTS A total of 6,691 patients were included and 553 (8.3%) received HD. North America had a higher HD-IE proportion than the other regions. The predominant microorganism was Staphylococcus aureus (47.8%), followed by enterococci (15.4%). Both in-hospital and 6-month mortality were significantly higher in HD versus non-HD-IE patients (30.4% vs. 17% and 39.8% vs. 20.7%, respectively; p < 0.001). Cardiac surgery was less frequently performed among HD patients (30.6% vs. 46.2%; p < 0.001), whereas relapses were higher (9.4% vs. 2.7%; p < 0.001). Risk factors for 6-month mortality included Charlson score (hazard ratio [HR]: 1.26; 95% confidence interval [CI]: 1.11 to 1.44; p = 0.001), CNS emboli and other emboli (HR: 3.11; 95% CI: 1.84 to 5.27; p < 0.001; and HR: 1.73; 95% CI: 1.02 to 2.93; p = 0.04, respectively), persistent bacteremia (HR: 1.79; 95% CI: 1.11 to 2.88; p = 0.02), and acute onset heart failure (HR: 2.37; 95% CI: 1.49 to 3.78; p < 0.001). CONCLUSIONS HD-IE is a health care-associated infection chiefly caused by S. aureus, with increasing rates of enterococcal IE. Mortality and relapses are very high and significantly larger than in non-HD-IE patients, whereas cardiac surgery is less frequently performed.
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Pericàs et al. (2021) conducted a cohort in Infective endocarditis (n=6,691). Chronic hemodialysis vs. Non-hemodialysis was evaluated on 6-month mortality (p=<0.001). Chronic hemodialysis in patients with infective endocarditis was associated with significantly higher 6-month mortality compared to non-hemodialysis patients (39.8% vs. 20.7%; p<0.001).
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