Sex Differences in Characteristics of Patients with Infective Endocarditis: A Multicenter Study

Abstract

Infectious diseases like infective endocarditis (IE) may manifest or progress differently between sexes. This study sought to identify the differences in demographic and clinical characteristics among male and female patients with IE. Data were obtained from a newly developed registry comprising all adult patients with first IE admission at the four major tertiary cardiovascular centers in West Virginia, USA during 2014–2018. Patient characteristics were compared between males and females using Chi-square test, Fisher’s exact test, and Wilcoxon rank-sum test. A secondary analysis was restricted to IE patients with drug use only. Among 780 unique patients (390 males, 390 females), significantly more women (a) were younger than males (median age 34.9 vs. 41.4, p < 0.001); (b) reported drug use (77.7% vs. 64.1%, p < 0.001); (c) had tricuspid valve endocarditis (46.4% vs. 30.8%, p < 0.001); and (d) were discharged against medical advice (20% vs. 9.5%, p < 0.001). These differences persisted even within the subgroup of patients with drug use-associated IE. In a state with one of the highest incidences of drug use and overdose deaths, the significantly higher incident IE cases in younger women and higher proportion of women leaving treatment against medical advice are striking. Differential characteristics between male and female patients are important to inform strategies for specialized treatment and care.

Sex Differences in Infective Endocarditis: A Systematic Review

“…However, one study found no significant difference in age between the sexes [ 40 ]. Bhandari et al found this trend true when they found that females admitted for drug use-associated IE tended to be significantly younger than males [ 32 ]. Despite the age differences in developing IE between sexes, it was found that the overall incidence rates of IE progressively increased with age [ 12 ].…”

“…On average, males comprised 65.8% of patients who developed IE, while females comprised only 34.2% of patients [ 12 , 14 - 19 , 21 - 23 , 26 , 27 , 29 - 31 ]. However, one study done in 2022 found that the incidence of developing IE between males and females was equal [ 32 ].…”

“…This trend could be due to a growing number of adults with congenital heart disease, an aging population with multiple health issues, shifts in healthcare practices, increased IV drug abuse rates, and improved detection due to advanced diagnostic techniques [ 33 ]. Two studies observed that the increasing trend in the development of IE did not vary between the sexes [ 12 , 32 ]. The remainder of the studies observed that with the growing trend in IE, males had a higher increase in detection than females, and only one study observed this as a non-significant trend [ 20 , 22 , 24 , 33 , 34 ].…”

“…Three other studies observed that females tended to be significantly younger than males [ 21 , 29 , 32 ]. Tariq et al observed that their patients were significantly younger than in more studies [ 29 ].…”

“…In assessing which side was affected the most between sexes in general, there was a complete split, with half observing that males were more likely to develop right-sided IE at 40.5%, and the other 75% of males developed left-sided IE [ 27 , 37 , 41 ]. When looking closely at the specific valves, females were more likely to develop IE of the mitral and tricuspid valve whether or not the valve was native or prosthetic [ 23 , 26 , 32 , 37 , 39 ]. Compared to females, males were more likely to develop IE in their aortic valves, especially native valves, with one study observing up to 73.9% [ 13 , 19 , 23 , 26 , 32 , 38 , 39 , 42 ].…”