Outcomes and Predictors of Inpatient Mortality for Infective Endocarditis in Patients with Malignancy: Contemporary Nationwide Study from the United States

Infective endocarditis (IE) in patients with malignancy represents a high-risk clinical cohort, yet nationwide data on outcomes and predictors of mortality remain limited. Using the United States National Inpatient Sample (2016-2022), we identified hospitalizations involving IE and a malignancy diagnosis. Inpatient mortality, complications, and temporal trends were analyzed overall and across malignancy subtypes, causative organisms, and prosthetic valve status. Survey-weighted multivariable logistic regression was performed across the full IE cohort. Of 635 715 IE hospitalizations, 44 060 (6.9%) involved a malignancy diagnosis. Inpatient mortality was higher in this group than among IE hospitalizations without malignancy (13.5% vs 9.8%; P < .001), and malignancy remained associated with mortality after adjustment (adjusted odds ratio 1.29; 95% CI 1.19-1.39; P < .001). The proportion of IE hospitalizations involving malignancy increased from 6.7% in 2016 to 7.7% in 2022. Fungal infection, shock, acute kidney injury, and stroke were associated with mortality. Prosthetic-valve IE had lower mortality than non-prosthetic-valve IE (7.7% vs 13.9%; P < .001). These findings identify a high-risk, heterogeneous phenotype and support earlier diagnostic evaluation and coordinated oncology, cardiology, and infectious diseases management.