Gender differences in clinical features and complications of infective endocarditis: 11-year experience of a single institute in Egypt

Abstract

Background: No data exists about the gender differences among patients with infective endocarditis (IE) in Egypt. The objective was to study possible gender differences in clinical profiles and outcomes of patients in the IE registry of a tertiary care center over 11 years. Results: The IE registry included 398 patients with a median age of 30 years (interquartile range, 15 years); 61.1% were males. Males were significantly older than females. Malignancy and recent culprit procedures were more common in females while chronic liver disease and intravenous drug abuse (IVDU) were more in males. IE on top of structurally normal hearts was significantly more in males (25.6% vs 13.6%, p = 0.005) while rheumatic valvular disease was more common in females (46.3% vs 29.9%, p = 0.001). There was no difference in the duration of illness before presentation to our institution. The overall complication rate was high but significantly higher in females. However, there were no significant differences in the major complications: mortality, fulminant sepsis, renal failure requiring dialysis, heart failure class III-IV, or major cerebrovascular emboli. Conclusion: In this registry, IE occurred predominantly in males. Females were significantly younger at presentation. History of recent culprit procedures was more common in females while IVDU was more common in males who had a higher incidence of IE on structurally normal hearts. The overall complication rate was higher in women. IE management and its outcomes were similar in both genders.

Predictors of mortality and adverse events in patients with infective endocarditis: a retrospective real world study in a surgical centre

“…Estrogens may play a protective role against endothelial damage. Moreover, females tend to encounter heart disease at an older age and have a higher incidence of comorbid conditions, which may result in a worse outcome [ 2 , 3 ]. Deepening the analysis, we found that the female gender was not an independent predictor of adverse prognosis, as opposed to age and EUROSCORE II, that confirmed to be independent predictors at multivariate analysis.…”

“…Despite recent diagnostic and therapeutic advances, the mortality of IE remains high in most series, with in-hospital mortality even of 24% [ 1 ], and three-year mortality over 30% [ 2 ]. The literature reports some prognostic factors associated with higher mortality, such as advanced age, female gender [ 1 – 3 ], prosthetic valve endocarditis [ 4 ], Staphylococcus aureus aetiology [ 5 ], comorbidity [ 6 – 12 ], leucocytosis, hypoalbuminemia, C-reactive protein levels, elevated ERS [ 13 ], and IE complications [ 6 ].…”

“…age, female gender [1][2][3], prosthetic valve endocarditis [4], Staphylococcus aureus aetiology [5], comorbidity [6][7][8][9][10][11][12], leucocytosis, hypoalbuminemia, C-reactive protein levels, elevated ERS [13], and IE complications [6].…”

Gender Based Analysis of a Population Series of Patients Hospitalized with Infective Endocarditis in Portugal – How do Women and Men Compare?

“…Moreover, a recent systematic review of observational series from Portugal 17 concluded that a higher prevalence of men was noted in all studies and this predominance was also noted in all surgical series (men constituted more than two-thirds of all operated patients). Still, scarce and conflicting evidence persists regarding the influence of gender on the access to cardiac surgery and fatal outcome, [18][19][20][21][22][23][24] being mostly based on single-center cohorts. Populational studies addressing this issue are rare, 23 yet crucial to avoid selection bias in observational studies performed in tertiary centers.…”

Valvular heart diseases in women

“…A recent study that explored the sex-related differences in patients with infective endocarditis has shown that women are characteristically younger, are more predisposed to cardiac lesions (rheumatic mainly), and suffer more complications than men. Alternatively, men with infective endocarditis mostly were intravenous drug abusers on a background of a structurally normal heart [35].…”