Pulmonary complications observed in patients with infective endocarditis with and without injection drug use: An analysis of the National Inpatient Sample

Abstract

Background The impact of cardiovascular and neurologic complications on infective endocarditis (IE) are well studied, yet the prevalence and significance of pulmonary complications in IE is not defined. To better characterize the multifaceted nature of IE management, we aimed to describe the occurrence and significance of pulmonary complications in IE, including among persons with IE related to drug use. Methods Hospitalizations of adult (≥18 years old) patients diagnosed with IE were identified in the 2016 National Inpatient Sample using ICD-10 codes. Multivariable logistic and linear regression were used to compare IE patient outcomes between those with and without pulmonary complications and to identify predictors of pulmonary complications. Interaction terms were used to assess the impact of drug-use IE (DU-IE) and pulmonary complications on inpatient outcomes. Results In 2016, there were an estimated 88,995 hospitalizations of patients diagnosed with IE. Of these hospitalizations,15,490 (17%) were drug-use related. Drug-use IE (DU-IE) had the highest odds of pulmonary complications (OR 2.97, 95% CI 2.50, 3.45). At least one pulmonary complication was identified in 6,580 (7%) of IE patients. DU-IE hospitalizations were more likely to have a diagnosis of pyothorax (3% vs. 1%, p<0.001), lung abscess (3% vs. <1%, p<0.001), and septic pulmonary embolism (27% vs. 2%, p<0.001). Pulmonary complications were associated with longer average lengths of stay (CIE 7.22 days 95% CI 6.11, 8.32), higher hospital charges (CIE 78.51 thousand dollars 95% CI 57.44, 99.57), more frequent post-discharge transfers (acute care: OR 1.37, 95% CI 1.09, 1.71; long-term care: OR 2.19, 95% CI 1.83, 2.61), and increased odds of inpatient mortality (OR 1.81 95% CI 1.39, 2.35). Conclusion and relevance IE with pulmonary complications is associated with worse outcomes. Patients with DU-IE have a particularly high prevalence of pulmonary complications that may require timely thoracic surgical intervention, likely owing to right-sided valve involvement. More research is needed to determine optimal management strategies for complications to improve patient outcomes.

Risk Factors Associated with Poor Outcome in Patients with Infective Endocarditis: An Italian Single-Center Experience

“…In our study, extra-cerebral embolization was present in 29.4% of IE cases, a percentage higher than previous data from the literature, i.e., 17% according to ICE-PCS [ 22 ]. Nevertheless, neither splenic nor pulmonary or renal embolic phenomena were related to a poor intra-hospital outcome; this means that in our experience extra-cerebral embolic involvement could not represent a prognostic factor, as reported in other studies [ 2 , 26 , 27 ].…”

Infective Endocarditis-Induced Lung Injury Mimicking Acute Vanishing Lung Syndrome

“…Pulmonary complications of endocarditis are seen in approximately 7% of patients; however, among patients with IE who are intravenous drug users, pulmonary complications may occur in up to 75%. These complications include pneumonia, lung abscess, pleural effusion, empyema, pulmonary hemorrhage, and rarely pneumothorax [ 1 , 3 ]. Pulmonary abscess formation can lead to the development of large pneumatoceles even after the initiation of appropriate antibiotics.…”

Perioperative Complications in Infective Endocarditis

“…Septic emboli can cause pulmonary embolism, leading to pulmonary infarction, abscesses, and pleural empyema. Immune-mediated injury can result in vasculitis and diffuse alveolar hemorrhage, and direct infection of the lung can cause pneumonia [65]. The incidence of pulmonary complications in IE ranges from 4 to 10%, depending on the patient population.…”

“…The incidence of pulmonary complications in IE ranges from 4 to 10%, depending on the patient population. Patients with a cardiac implantable electronic device (CIED) and active intravenous (iv) drug abuse are particularly at risk for pulmonary complications [6,21,65].…”