Prognostic factors of infective endocarditis in patients on hemodialysis: A case series from a National Multicenter Registry

Abstract

Background: Infective endocarditis (IE) is a severe complication associated with high mortality.

Objectives: To examine the clinical characteristics of IE in hemodialysis (HD) patients and to determine prognostic factors related to HD.

Methods: From January 2008 to April 2015, 2488 consecutive patients with definite IE were included. Clinical characteristics of IE patients on HD were compared with those of IE patients who were not on HD.

Results: A total of 126 patients (63% male, median age: 66years; IQR: 54-74years) with IE (5.1%) were on HD. Fifty-two patients died during hospitalization (41%) and 17 additional patients (14%) died during the first year. The rate of patients who underwent surgery during hospitalization was lower in HD patients (38 patients, 30%) than in non-HD patients (1177 patients, 50%; p<0.001). Age >70years (OR: 4.1, 95% CI: 1.7-10), heart failure (OR: 3.3, 95% CI: 1.4-7-6), central nervous system (CNS) vascular events (OR: 6.7, 95% CI: 2.1-22) and septic shock (OR: 4.1, 95% CI: 1.4-12.1) were independently associated with fatal outcome in HD patients. Of the 38 patients who underwent surgery, 15 (39.5%) died during hospitalization.

Conclusions: HD patients with IE present a high mortality. Advanced age and complications, such as heart failure, CNS stroke or septic shock, are associated with mortality.

Keywords: Age; Cardiac surgical procedure; Endocarditis; Enterococcus; Hemodialysis; Mortality; Staphylococcus aureus.