Gender differences in infective endocarditis: Pre- and co-morbid conditions lead to different management and outcomes in female patients

Abstract

The impact of gender on the presenting characteristics, management, and outcomes in infective endocarditis (IE) has not been adequately studied. The goal of our study was to better understand differences in management and outcome of IE between genders. Data were obtained prospectively from 439 patients in the Duke Endocarditis Database from 1996 to 2004. Baseline characteristics of patients were examined using univariable analysis. Variables associated with gender, in-hospital surgery and long-term mortality in patients with IE were considered for multivariable analysis. Hemodialysis, diabetes mellitus, and immunosuppression were more frequent in female patients with IE. Intracardiac abscesses and new conduction abnormalities were more common in male patients. The following factors were predictive of short-term mortality through univariable analysis: female gender, age, diabetes mellitus, septic pulmonary infarcts, intracranial hemorrhage, infection with Staphylococcus aureus, and persistently positive blood cultures. Female gender was not associated with mortality in an adjusted analysis of short-term outcome. Age, diabetes mellitus, renal failure requiring hemodialysis, cancer, pulmonary edema, systemic embolization, persistently positive blood cultures, and chronic indwelling central catheters but not female gender were associated with long-term mortality using univariable and an adjusted analysis. In both analyses, surgery was associated with improved mortality. Female gender, a history of diabetes mellitus, hemodialysis, and immunosuppression therapy were predictive of a medical management without the use of surgery, although in the adjusted analysis there was no association between surgery and gender. In conclusion, differences between genders in treatment and outcomes frequently reported in patients with IE most likely result from pre- and co-existing conditions such as diabetes mellitus, renal failure requiring hemodialysis, and chronic immunosuppression.

Relationships between sex, early valve surgery and mortality in patients with left-sided infective endocarditis analysed in a population-based cohort study

“…Compared with the two major publications about sex differences in IE,7 10 our findings are similar in terms of women's demographics and baseline characteristics: women with IE are older than men, more often on haemodialysis and more often have a mitral valve IE. In all three studies, women underwent EVS less often than men.…”

“…In their study performed in 439 patients (187 women), Aksoy et al found that female sex was associated with a lower rate of EVS but was not associated with mortality after adjustment for confounding factors. The authors suggested that sex difference in the rate of EVS resulted mainly from pre-existing and/or coexisting conditions such as diabetes, haemodialysis and chronic immunosuppression, which were more frequent in women 7. The study by Sambola et al , performed on 271 patients (88 women), found different results.…”

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“…Furthermore, female patients may have a worse prognosis and undergo valve surgery less frequently than their male counterparts. 27 Types of infective endocarditis IE should be regarded as a set of clinical situations which are sometimes very different from each other. In an attempt to avoid overlap, the following four categories of IE must be separated, according to the site of infection and the presence or absence of intracardiac foreign material: left-sided native valve IE, left-sided prosthetic valve IE, right-sided IE, and device-related IE (the latter including IE developing on pacemaker or defibrillator wires with or without associated valve involvement) ( Table 3).…”

An unusual venous thrombosis complicated with infective endocarditis

“…Infective endocarditis is sometimes complicated with infective emboli to lung, spleen, kidney and brain. The point is that early diagnosis is essential [11], sometime surgical interventions or also valve replacement is required [8]. In our patient also due to severity of mitral valve involvement, it was replaced with a metal one.…”

“…The physician must have a good clinical insight for diagnosing and choosing of better diagnostic method like TEE in his or her approach to disease [10]. TEE in comparison with TTE gets better quantitative and qualitative data regarding presence of IE and level of value dysfunction [11]. Staphylococci and streptococci are the most frequent germs and medication for covering of both of them was started initially (due to clinical suspicious) [8].…”