Trends and outcomes of infective endocarditis in patients on dialysis

Abstract

Dialysis patients are at high risk for infective endocarditis (IE); however, no large contemporary data exist on this issue. We examined outcomes of 44 816 patients with IE on dialysis and 202 547 patients with IE not on dialysis from the Nationwide Inpatient Sample database from 2006 thorough 2011. Dialysis patients were younger (59 AE 15 years vs 62 AE 18 years) and more likely to be female (47% vs 40%) and African-American (47% vs 40%; all P < 0.001). Hospitalizations for IE in the dialysis group increased from 175 to 222 per 10 000 patients (P trend = 0.04). Staphylococcus aureus was the most common microorganism isolated in both dialysis (61%) and nondialysis (45%) groups. IE due to were less likely (all P < 0.001). Dialysis patients had higher in-hospital mortality (aOR: 2.13, 95% CI: 2.04-2.21), lower likelihood of valve-replacement surgery (aOR: 0.82, 95% CI: 0.76-0.86), and higher incidence of stroke (aOR: 1.08, 95% CI: 1.03-1.12; all P < 0.001). We demonstrate rising incidence of IE-related hospitalizations in dialysis patients, highlight significant differences in baseline comorbidities and microbiology of IE compared with the general population, and validate the association of longterm dialysis with worse in-hospital outcomes. K E Y W O R D SInfective Endocarditis, End-Stage Renal Disease, Outcomes

Chronic dialysis patients with infectious spondylodiscitis have poorer outcomes than non-dialysis populations

“… 20 , 21 In ESRD patients diagnosed with infective endocarditis, smaller studies did not find differences in mortality; 22 , 23 however, a larger nationwide study involving ~250,000 patients in the USA found a significantly higher in-hospital mortality in ESRD populations. 24 …”

Comparison of clinical characteristics and outcomes of infective endocarditis between haemodialysis and non-haemodialysis patients in China

“…Patients with AKI who concomitantly required haemodialysis, and patients with CKD who were not receiving long-term haemodialysis, were excluded. 12 …”

“…The primary outcome of interest was all-cause in-hospital mortality, defined as ‘died’ during hospitalization. 12 …”

Cardiac transplantation for hypertrophic cardiomyopathy in the United States 2003–2011

“…Data were obtained from the Nationwide Inpatient Sample database, a part of the Healthcare Cost and Utilization sponsored by the Agency for Healthcare Research and Quality, for calendar years 2003 through 2011 as previously described. [ 21 22 23 ] The database contains discharge-level data for ~8 million hospital stays from ~1000 hospitals each year. It is designed to approximate a 20% stratified sample of community hospitals.…”