Key result
Culture-negative endocarditis shows similar long-term survival to culture-positive cases, but worse outcomes in females.
Why the study?
Culture-negative infective endocarditis presents diagnostic and therapeutic challenges with potentially worse clinical outcomes compared to culture-positive infective endocarditis.
Does culture-negative infective endocarditis affect long-term mortality compared to culture-positive infective endocarditis in patients undergoing surgery?
Cohort (n=698)
No
Does culture-negative infective endocarditis affect long-term mortality compared to culture-positive infective endocarditis in patients undergoing surgery?
Hazard Ratio: 1.08 (95% CI 0.56–1.51)
Absolute Event Rate: 14% vs 12%
p-value: p=0.75
Patients with culture-negative infective endocarditis undergoing surgery have comparable long-term survival to those with culture-positive endocarditis, though they experience a higher rate of postoperative renal replacement therapy and female patients face a significantly worse prognosis.
Similar survival after surgery for culture-negative IE supports current indications; leaves open sex-specific risks and renal mediation in observational data.
Background Culture‐negative infective endocarditis (CNIE) presents significant diagnostic and therapeutic challenges due to the absence of identifiable pathogens, leading to empirical antibiotic treatment and potentially worse clinical outcomes. This study aims to compare the clinical characteristics, surgical outcomes, and long‐term prognoses of patients with CNIE and culture‐positive infective endocarditis. Methods A total of 698 patients who underwent surgery for infective endocarditis between 2013 and 2024 were included, with 154 (22.1%) classified as CNIE. Baseline, intraoperative, and postoperative factors were analyzed in several ways including multivariate Cox regression and structural equation modeling. Results Patients with CNIE had worse preoperative cardiac and renal function and a higher incidence of postoperative renal replacement therapy. While overall long‐term survival did not differ significantly between CNIE and culture‐positive infective endocarditis, female patients with CNIE showed a significantly worse prognosis (hazard ratio, 2.13 [95% CI, 1.02–4.43]; P =0.04). Mediation analysis indicated that reduced renal function (estimated glomerular filtration rate) partially mediated the relationship between culture status and death, highlighting a potential mechanism. Conclusions Although the survival rates of patients with CNIE and culture‐positive infective endocarditis are similar, the prognosis of female patients with CNIE is significantly worse.
No takes yet. Share an insight, caveat, or question.
Zhang et al. (2025) conducted a cohort in Infective endocarditis requiring surgery (n=698). Culture-negative infective endocarditis vs. Culture-positive infective endocarditis was evaluated on Long-term cumulative mortality (HR 1.08, 95% CI 0.56-1.51, p=0.75). Culture-negative infective endocarditis was associated with similar overall long-term survival compared to culture-positive infective endocarditis (HR 1.08), though female patients had significantly worse prognosis.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: