In-Hospital and Long-Term Outcomes of Infective Endocarditis in Chronic Dialysis Patients

Abstract

Purpose: To elucidate the in-hospital and long-term outcomes of infective endocarditis (IE) in end-stage kidney disease (ESKD) patients on chronic dialysis and to analyze the risk factors of mortality. Patients and Methods: The case files of 1,817 patients who were hospitalized for IE over a 14-year period were retrospectively reviewed. Of these, 116 ESKD patients on chronic dialysis were enrolled in this study. Cox's proportional hazard model was used to evaluate the risk factors of mortality and long-term outcomes. Results: The in-hospital mortality rate of the 116 enrolled patients was as high as 43.1%. Patients who survived the index admission had a three-year mortality rate of 33%. Univariate analysis was used to compare survivors and non-survivors; poor in-hospital outcomes were associated with the use of a tunneled cuffed catheter for dialysis access, a shorter duration hospitalization, shock or respiratory failure during hospitalization, a higher white blood count, a higher percentage of polymorphonuclear leukocytes, a higher C-reactive protein level, a lower serum albumin level, and a higher total bilirubin level. Following multivariate adjustment, shock (odds ratio, 9.29, with a 95% confidence interval [CI] of 2.78 to 34.24; p<0.001) or respiratory failure (odds ratio, 25.16, with a 95% CI of 5.63 to 153.54; p<0.001) during hospitalization was strongly associated with increased in-hospital mortality. Patients who underwent cardiac operations (odds ratio, 0.22, with a 95% CI of 0.052 to 0.86; p=0.031) had better in-hospital outcomes. Heart failure reduced ejection fraction (HFrEF) at the time of initial hospitalization was an independent risk factor for 3-year mortality (hazard ratio, 3.48, with a 95% CI of 1.09 to 11.09; p=0.035). Conclusion: The outcomes of IE for ESKD patients on chronic dialysis were poor. Only 56.9% of these patients survived the index admission and their mortality rate over three years was 33%. Shock or respiratory failure during hospitalization was associated with increased in-hospital mortality. Patients who underwent cardiac operations had better in-hospital outcomes. HFrEF at the time of initial hospitalization was an independent risk factor for threeyear mortality.

Short- and long-term outcomes of infective endocarditis admission in adults: A population-based registry study in Finland

“…To assess the burden of possible risk factors, we used the CCI score [25]. Unfortunately, we did not have the information of the possible hemodialysis, which has been reported to be associated with increased mortality in IE [44][45][46]. Additionally, some of the diagnoses might be missing and there might be errors in coding.…”

Infective Endocarditis Hospitalizations and Outcomes in Patients With End‐Stage Kidney Disease: A Nationwide Data‐Linkage Study

“…In addition, the in‐hospital mortality described in a recently published single‐center study from Taiwan was approximately double the figure we report at 30 days, despite similar Staphylococcus aureus infection rates. 11 Bhatia and colleagues 12 previously demonstrated a comparable increased risk of death in patients with and without ESKD. Although well‐powered, their analysis was restricted to in‐hospital death only.…”

Vacuum-assisted thrombectomy of a right atrial vegetation in a patient with infective endocarditis

“…[3] In patients with end-stage renal disease requiring HD, the mortality rate can reach 43.1%. [4] Surgical management, when indicated, becomes problematic in elderly and critically ill patients due to the increased risks inherent to the operative approach. ere are currently no guidelines, however, regarding minimally invasive approaches to achieve source control in these patients.…”