Sex-Specific Risk Factors for Short- and Long-Term Outcomes after Surgery in Patients with Infective Endocarditis

Friedrich, Christine; Salem, Mohamed A.; Puehler, Thomas; Panholzer, Bernd; Herbers, Lea; Reimers, J. H. W. Th.; Hummitzsch, Lars; Cremer, Jochen; Haneya, Assad

doi:10.3390/jcm11071875

Cited by 10 publications

(43 citation statements)

References 32 publications

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“…A single-center retrospective observational study of 413 patients (25.4% female) who received surgery for IE showed that females had a higher 30-day mortality than males (26.7% versus 14.9%; P= 0.007). 176 Female sex was predictive for 30-day mortality (OR, 2.090 [95% CI, 1.077–4.053]; P =0.029).…”

Section: Valvular Diseasesmentioning

confidence: 99%

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

Martin,

Aday,

Almarzooq

et al. 2024

Circulation

169

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BACKGROUND: The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS: The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year’s worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year’s edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

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Section: Valvular Diseasesmentioning

confidence: 99%

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

Martin,

Aday,

Almarzooq

et al. 2024

Circulation

169

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“…Female gender has been shown to be an independent predictor for 30-day mortality in our previous study. 8 EuroScore II was significantly higher in our study group and was a good indicator for 30-day mortality. The EuroScore II in general is controversially discussed.…”

Section: Discussionmentioning

confidence: 42%

“…Also, 24 and 48-hour numbers of packed red blood cells, fresh-frozen plasma units, as well as platelet units showed highly significant differences (p < 0.001 for all). Ventilation time was significantly longer in the nonsurvivor group (41 [19,116] vs. 14 [8,36] hours; p < 0.001). Reintubation was also significantly higher (21.9 vs. 10.2%; p ¼ 0.008) and rate of bronchopulmonary infection (survivor 7.5 vs. nonsurvivor 24.6%, p < 0.001).…”

Section: Postoperative Datamentioning

confidence: 92%

Risk Factor Analysis for 30-day Mortality After Surgery for Infective Endocarditis

Jussli-Melchers,

Friedrich,

Mandler

et al. 2024

Thorac Cardiovasc Surg

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Background Infective endocarditis (IE) remains a challenging disease associated with high mortality. Several scores have been suggested to assess surgical risk. None was sufficiently adequate. We therefore analyzed risk factors for 30-day mortality. Methods A total of 438 consecutive patients had surgery for IE in our department between 2002 and 2020. Patients were divided into two groups, one consisting of 30-day survivors (362 patients; 82.6%) and one of nonsurvivors (76 patients; 17.4%). Logistic regression analysis on pre- and intraoperative risk factors was performed and the groups were compared by univariable analyses. Results Patients in mortality group were older (69 [58, 77] vs. 63 [50, 72] years; p < 0.001), EuroSCORE II was higher (24.5 [12.1, 49.0] vs. 8.95 [3.7, 21.2]; p < 0.001) and there were more females. More frequently left ventricular function (below 30%), preoperative acute renal insufficiency, chronic dialysis, insulin-dependent diabetes mellitus, NYHA-class IV (New York Heart Association heart failure class IV), and cardiogenic shock occurred. Patients in the mortality group were often intensive care unit patients (40.8 vs. 22.4%; p < 0.001) or had a preoperative stroke (26.3 vs. 16.0%; p = 0.033). In the nonsurvivor group Staphylococcus aureus was prevalent. Streptococcus viridans was common in the survivor group as was isolated aortic valve endocarditis (32.9 vs. 17.1%; p = 0.006). Prosthetic valve endocarditis (PVE) and abscesses occurred more often in nonsurvivors. In the logistic regression analysis, female gender, chronic dialysis, cardiogenic shock, and NYHA IV and from intraoperative variables PVE, cardiopulmonary bypass time, and mitral valve surgery were the strongest predictors for 30-day mortality. Conclusion This study indeed clearly indicates that significant risk factors for 30-day mortality cannot be changed. Nevertheless, they should be taken into account for preoperative counselling, and they will alert the surgical team for an even more careful management.

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“…The incidence rate of IE in males was, on average, 11.39/100,000 person-years; in females, it was 5.24/100,000 person-years [ 12 , 24 ]. 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 ].…”

Section: Reviewmentioning

confidence: 99%

“…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 ].…”

Section: Reviewmentioning

confidence: 99%

Sex Differences in Infective Endocarditis: A Systematic Review

Slouha,

Al-Geizi,

Albalat

et al. 2023

Cureus

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Despite the advancement in medicine, there is still a lack of understanding of the sex disparities in disease onset, progression, treatment, and outcome. In some life-threatening acute conditions, despite most patients with these illnesses being males, females have a significantly higher chance of mortality. This can be due to the differences in disease progression or healthcare disparities in managing the illness between the sexes. Treatment of illnesses tends to be more conservative for women without an explanation, but this disparity is due to the healthcare provider. Infective endocarditis (IE) is an acute life-threatening condition where bacteria latch onto and seed damaged endocardium, with some preliminary information reporting differences between the sexes. This paper aims to evaluate the sex disparities in the incidence, age, comorbidities, etiology, risk factors, manifestations, treatment, and outcomes of IE. From 2003-2023, 21584 articles were found that focused on the sex differences in IE and, through PRISMA guidelines, were narrowed down to 34 publications. There are significant differences between the sexes in IE, such as a significantly higher incidence of IE in males, who also tend to be older and have their native aortic valves involved, compared to younger females who have their mitral valve involved. Comorbidities also vary between the sexes; females tend to have atrial fibrillation, chronic kidney disease, psychiatric disorders, and taking immunosuppressants compared to males who suffer from chronic liver disease, underlying valve disease, and peripheral artery disease, contributing to the ease of developing IE. While the most common microorganism leading to IE is Staphylococcus aureus, females were more likely to have culture-negative IE, and men were more likely to be infected with Streptococcus viridans. Major manifestations in IE are fever and vegetation along the closure of the valves in the heart, where females were more likely to have vegetation on the mitral and aortic valves. At the same time, males were more likely to have it on the tricuspid valve. On par with sex disparities in health, females usually took longer to seek medical help than males despite the advancement of symptoms and deterioration. Females were also treated conservatively through antibiotic management, whereas males were more likely to advance to surgical treatment, leading to a longer hospital stay. While there was no true difference in the in-hospital mortality rate, the 30-day and 1-year mortality were significantly increased in females. These differences provide a range of starting points for various research to further educate physicians on sex disparities, such as why males have a higher incidence of infective endocarditis and determining whether it’s hormones and basic metabolites, possibly limiting those who develop the infection. Another important point is treating females with IE; the antibiotic doses are standard, but whether they...

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Sex-Specific Risk Factors for Short- and Long-Term Outcomes after Surgery in Patients with Infective Endocarditis

Cited by 10 publications

References 32 publications

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

Risk Factor Analysis for 30-day Mortality After Surgery for Infective Endocarditis

Sex Differences in Infective Endocarditis: A Systematic Review

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