Microbiological features, clinical characteristics and outcomes of infective endocarditis in adults with and without hemodialysis: A 10-year retrospective study in Northern Taiwan

Wang, Chien-Yao; Wang, Yung-Chih; Yang, Ya-Sung; Chang, C.; Chen, Kuan‐Yu; Lai, Jiun-Ji; Lin, Jung‐Chung; Chang, Feng–Yee

doi:10.1016/j.jmii.2018.08.013

Cited by 12 publications

(10 citation statements)

References 37 publications

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“…Staphylococcus aureus has been reported to be the predominant causative pathogen of IE in chronic dialysis patients. 8,22 Consistent with this finding, S. aureus was the most common organism (35.3%) in our study group. Moreover, MRSA endocarditis reportedly has higher mortality than endocarditis that is caused by most other microorganisms.…”

Section: Dovepresssupporting

confidence: 90%

In-Hospital and Long-Term Outcomes of Infective Endocarditis in Chronic Dialysis Patients

Liau

Kuo

Chen

et al. 2021

IJGM

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Purpose: To elucidate the in-hospital and long-term outcomes of infective endocarditis (IE) in end-stage kidney disease (ESKD) patients on chronic dialysis and to analyze the risk factors of mortality. Patients and Methods: The case files of 1,817 patients who were hospitalized for IE over a 14-year period were retrospectively reviewed. Of these, 116 ESKD patients on chronic dialysis were enrolled in this study. Cox's proportional hazard model was used to evaluate the risk factors of mortality and long-term outcomes. Results: The in-hospital mortality rate of the 116 enrolled patients was as high as 43.1%. Patients who survived the index admission had a three-year mortality rate of 33%. Univariate analysis was used to compare survivors and non-survivors; poor in-hospital outcomes were associated with the use of a tunneled cuffed catheter for dialysis access, a shorter duration hospitalization, shock or respiratory failure during hospitalization, a higher white blood count, a higher percentage of polymorphonuclear leukocytes, a higher C-reactive protein level, a lower serum albumin level, and a higher total bilirubin level. Following multivariate adjustment, shock (odds ratio, 9.29, with a 95% confidence interval [CI] of 2.78 to 34.24; p<0.001) or respiratory failure (odds ratio, 25.16, with a 95% CI of 5.63 to 153.54; p<0.001) during hospitalization was strongly associated with increased in-hospital mortality. Patients who underwent cardiac operations (odds ratio, 0.22, with a 95% CI of 0.052 to 0.86; p=0.031) had better in-hospital outcomes. Heart failure reduced ejection fraction (HFrEF) at the time of initial hospitalization was an independent risk factor for 3-year mortality (hazard ratio, 3.48, with a 95% CI of 1.09 to 11.09; p=0.035). Conclusion: The outcomes of IE for ESKD patients on chronic dialysis were poor. Only 56.9% of these patients survived the index admission and their mortality rate over three years was 33%. Shock or respiratory failure during hospitalization was associated with increased in-hospital mortality. Patients who underwent cardiac operations had better in-hospital outcomes. HFrEF at the time of initial hospitalization was an independent risk factor for threeyear mortality.

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Section: Dovepresssupporting

confidence: 90%

In-Hospital and Long-Term Outcomes of Infective Endocarditis in Chronic Dialysis Patients

Liau

Kuo

Chen

et al. 2021

IJGM

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“…A previous study reported that the causative pathogen is S. aureus in 40–63.6% of haemodialysis patients with IE, and haemodialysis patients have a higher proportion of MRSA than non-haemodialysis patients. 20 The present study identified the microbiological aetiology of IE as MRSA and Enterococcus in the majority of haemodialysis patients. By contrast, Streptococcus was the main pathogen in non-haemodialysis patients during the same period.…”

Section: Discussionmentioning

confidence: 82%

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

Zhang

Liu

et al. 2020

J Int Med Res

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Objective To clarify differences in clinical characteristics and outcomes between patients with infective endocarditis (IE) receiving long-term haemodialysis (HD group) and those not receiving haemodialysis (non-HD group). Methods Medical records of patients with IE, admitted to hospital between January 2010 and December 2017, were retrospectively studied. Clinical characteristics and outcomes were compared between HD and non-HD groups. Risk factors for IE were assessed by COX regression. Results Twenty-one HD and 143 non-HD patients were included. Predisposing heart conditions were more frequently observed in the non-HD versus HD group (90.9% versus 19.0%). Inappropriate antibiotic therapy rate before admission and proportion of methicillin-resistant Staphylococcus aureus and Enterococcus-associated IE was higher in the HD versus non-HD group. In the HD group, fewer patients underwent heart surgery (9.5% versus 51.7%), all-cause in-hospital mortality was higher (52.4% versus 21%), and survival rate was lower versus the non-HD group. COX regression analysis revealed that haemodialysis, use of central venous catheter (CVC) and inappropriate antibiotic therapy before admission increased IE mortality, while surgery improved long-term prognosis. Conclusions Haemodialysis patients with IE may have higher mortality and lower survival rates than patients with IE not receiving haemodialysis. Haemodialysis, use of CVC and inappropriate antibiotic therapy before admission may increase IE mortality. Surgery may improve long-term prognosis.

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“…Although a small number of clinical markers were reported to not be responsible for the mortality and occurrence of MAEs in this population (5,11,12), the role of glucose levels and variability has not yet been investigated. Glucose levels are frequently monitored in the ICU, which makes GV a simple and cost-effective indicator for the prognostic Variables of postoperative glycemic fluctuation are presented as medians (interquartile range), the enumeration data are presented as n (%).…”

Section: Discussionmentioning

confidence: 92%

“…The univariate analysis indicated that postoperative MAEs were associated with age, systemic emboli, staphylococcus infection, uncontrolled infection, prosthetic valve endocarditis, emergency surgery, vegetation size ≥10 mm and both mitral and aortic involvement. In the previous studies, these risk factors were reported to be associated in varying degrees with the outcomes of IE patients (12,14,15). On the other hand, although in the current study hemoglobin A1c did not show any significant difference between patients with and without MAEs, the study by Subramaniam et al demonstrated that preoperative hemoglobin A1c identifies the risk for postoperative glycemic variability and had somewhat of an effect on the incidence of MAEs following bypass surgery (16); thus, we also included hemoglobin A1c in our model to minimize its influence on postoperative glycemic variability.…”

Section: Evaluation Of Ie Patients a Meta-analysis Of Twelvementioning

confidence: 99%

Increased glucose variability is associated with major adverse events in patients with infective endocarditis undergo surgical treatment

Liang¹,

Xiong²,

Zhang³

et al. 2021

J Thorac Dis

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Background: This study aimed to investigate the prognostic value of glucose variability (GV) in predicting postoperative major adverse events (MAEs) in patients with infective endocarditis (IE) who underwent surgical treatment. Methods: This retrospective observational study included a total of 381 consecutive patients who underwent surgical treatment in our institution from October 2007 to August 2019. The MAEs included allcause death, stroke, myocardial infarction, acute heart failure, IE recurrence, acute renal failure and sepsis.Postoperative GV in the first 24 hours was measured by the mean 24-hour glucose, standard deviation, coefficient of variation (CV) and mean amplitude of glycemic excursions. Univariate and multivariate logistic regression analyses were performed to identify the independent association of GV with MAEs.Results: Of the 381 patients, 79 (20.7%) developed MAEs. The 30-day mortality of the overall study cohort was 5.23%. The multivariate logistic regression analysis indicated that 24-hour GV, measured as the CV [odds ratio (OR) =1.49, 95% CI, 1.23-3.57, P=0.012], was significantly associated with MAEs in IE patients. For every 10% increase in 24-hour CV, there was a 49% increase in the risk of MAEs. Furthermore, compared to patients in the low tertile of GV, patients in the top tertile of 24-hour GV had a higher 30-day mortality and an increased incidence of heart failure and hemodialysis as well as longer ventilation support. Conclusions: The results of this retrospective investigation demonstrated that increased GV measured by CV is an independent predictor of postoperative MAEs in patients undergoing surgical treatment for IE.

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Microbiological features, clinical characteristics and outcomes of infective endocarditis in adults with and without hemodialysis: A 10-year retrospective study in Northern Taiwan

Cited by 12 publications

References 37 publications

In-Hospital and Long-Term Outcomes of Infective Endocarditis in Chronic Dialysis Patients

In-Hospital and Long-Term Outcomes of Infective Endocarditis in Chronic Dialysis Patients

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

Increased glucose variability is associated with major adverse events in patients with infective endocarditis undergo surgical treatment

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