Risk factors and survival analysis of haemodialysis complicated with infective endocarditis

Abstract

The clinical features and risk factors for survival time were analysed in haemodialysis patients complicated with infective endocarditis. A total of 101 infective endocarditis (IE) patients treated at Hangzhou First People's Hospital, from January 1, 2012, to April 1, 2022, were included in the present study. Baseline demographic data and laboratory data were collected for statistical analysis of risk factors and survival time in the IE with haemodialysis group (HD-IE group, n=15) and the IE without haemodialysis group (NHD-IE group, n=86). Haemoglobin, red blood cells, C-reactive protein, procalcitonin, serum albumin, diabetes, invasive procedures, positive blood bacteria culture, heart valve calcification ratio, and left ventricular ejection fraction level were risk factors for infective endocarditis complicated with haemodialysis (P<0.05). Compared with the NHD-IE group, the HD-IE group had an obviously increased risk of mortality (χ²=6.323, P=0.012). The univariate Cox regression analysis showed that age, haemoglobin, red blood cells, serum albumin, left ventricular ejection score, longest vegetation diameter, combined hypotension and diabetes were risk factors for death; furthermore, multivariate Cox regression showed that age (HR=1.187, P=0.015), combined hypotension (HR=0.921, P=0.025) and the longest vegetation diameter (HR=9.191, P=0.004) were independent risk factors affecting the survival of patients. Collectively, the present study revealed that the mortality rate of HD-IE patients was higher than that of NHD-IE patients. Older age, hypotension, and the longest vegetation diameter were independent risk factors affecting the survival of patients. For HD-IE patients, active and effective antibiotic treatment or surgical treatment should be strongly recommended.

Keywords: clinical characteristics; haemodialysis; infective endocarditis; risk factors; survival analysis; treatment.

Figure 1

Valve involvement in IE patients. Injury of the aortic valve was most common in IE patients, followed by injury of the mitral valve, tricuspid valve, and pulmonary valve. IE, infective endocarditis.

Figure 2

Pathogens in the HD-IE and NHD-IE groups. In the general population, S. aureus is relatively common. In the NHD-IE group, the most common pathogen was revealed to be Streptococcus. In the HD-IE group, the most common pathogen was S. aureus. HD-IE, infective endocarditis with haemodialysis; NHD-IE, infective endocarditis without haemodialysis; S. aureus, Staphylococcus aureus.

Figure 3

Kaplan-Meier survival estimates. The results of the Breslow test showed that the difference in the survival rate between the two groups was significant (χ²=6.323, P=0.012). The results revealed that the NHD-IE group had a longer survival time than the HD-IE group, and HD-IE exhibited a higher early mortality rate. HD-IE, infective endocarditis with haemodialysis; NHD-IE, infective endocarditis without haemodialysis.