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

Abstract

Infective endocarditis (IE) is associated with high mortality. However, data on factors associated with length of stay (LOS) in hospital due to IE are scarce. In addition, long-term mortality of more than 1 year is inadequately known. In this large population-based study we investigated age and sex differences, temporal trends, and factors affecting the LOS in patients with IE and in-hospital, 1-year, 5-year and 10-year mortality of IE. Data on patients (≥18 years of age) admitted to hospital due to IE in Finland during 2005–2014 were collected retrospectively from nationwide obligatory registries. We included 2166 patients in our study. Of the patients 67.8% were men. Women were older than men (mean age 63.3 vs. 59.5, p<0.001). The median LOS was 20.0 days in men and 18.0 in women, p = 0.015. In the youngest patients (18–39 years) the median LOS was significantly longer than in the oldest patients (≥80 years) (24.0 vs. 16.0 days, p = 0.014). In-hospital mortality was 10% with no difference between men and women. Mortality was 22.7% at 1 year whereas 5- and 10-year mortality was 37.5% and 48.5%, respectively. The 5-year and 10-year mortality was higher in women (HR 1.18, p = 0.034; HR 1.18, p = 0.021). Both in-hospital and long-term mortality increased significantly with aging and comorbidity burden. Both mortality and LOS remained stable over the study period. In conclusion, men had longer hospital stays due to IE compared to women. The 5- and 10-year mortality was higher in women. The mortality of IE or LOS did not change over time.

Sex Differences in Infective Endocarditis: A Systematic Review

“…Along with comparing the incidence of IE between the sexes, it’s also been shown that there is a variation in the age at which each sex develops IE. Most patients with IE were between 60 and 79 years old, with an average of 62.2 years old [ 17 - 19 , 22 , 35 , 36 ]. Erichsen et al observed that the mean age of IE diagnosis in both sexes has increased steadily, but no study reports variations towards one sex [ 22 ].…”

“…Becher et al observed that hypertension is the highest comorbidity associated with patients with a diagnosis of IE at up to 44.9% [ 17 ]. In comparing the sexes, four studies observed differences in their Charlson comorbidity index, but many others found differences [ 20 , 26 , 35 , 40 ].…”

“…Between 2001 and 2020, admissions of IE grew significantly, with a median and mean length of stay being 20 days and 24 days, and tended to be significantly longer in patients who recorded a Charles comorbidity index of 0 [ 17 , 18 , 35 ]. It was observed that gram-negative bacteria seem to have a longer duration of infection as well as longer hospital stays [ 17 ].…”

“…Up to 3.9% of hospitalized patients undergo extraction of previously implanted cardiac devices [ 17 ]. Sometimes, a new prosthetic valve, pacemaker generator change, or pacemaker implantation must be done [ 17 , 35 ]. It is important to know that the number of patients per year receiving surgical treatment for IE has increased between 2002 and 2020 [ 16 , 23 ].…”

Correction to the article published in 2022: Epidemiologic and clinical characteristics of infective endocarditis: a single-center retrospective study in the Bronx, New York

“…However, there is a relative lack of data from low-and middle-income regions which can signi cantly affect the overall incidence of IE. A nationwide study from the United States (US) reported nearly half a million IE-related hospitalizations from 2000 to 2011 and a steady increase in its incidence [ [6][7][8][9][10][11] ]. The short-term mortality related to infective endocarditis has been estimated to be 10-24% [ 11 ].…”