Outcomes of infective endocarditis in patients with end-stage renal disease in Spain: a population-based study

Abstract

Background: Patients with end-stage renal disease (ESRD) have a higher risk of infective endocarditis (IE) and a worse prognosis associated with it. Our aim is to analyze the clinical characteristics and outcomes of patients with IE and ESRD in Spain, while exploring potential differences between patients undergoing dialysis and other patients with ESRD. Methods: Retrospective observational population-based study analyzing 9,008 episodes of IE recorded between 2016 and 2019, using data from the Spanish Minimum Basic DataSet. Among these, 428 patients had ESRD, including 332 who were undergoing dialysis. A multivariable and multilevel logistic regression model was constructed to assess the association between various factors and in-hospital mortality in ESRD patients. Results: Compared to patients without ESRD, those with ESRD were younger, had more comorbidities, and showed a higher prevalence of infections caused by Staphylococcus aureus (31.8% vs. 18.4%; p < 0.001) and coagulase-negative staphylococci (19.2% vs. 14%; p = 0.006). ESRD patients also experienced septic shock more frequently as an in-hospital complication (12.1% vs. 8.9%; p = 0.007). Additionally, they underwent cardiac surgery less often (12.6% vs. 19.6%; p < 0.001) and had significantly higher in-hospital mortality rates (33.4% vs. 26.9%; p = 0.003) than patients without ESRD. Among ESRD patients, those undergoing dialysis had more comorbidities and a higher proportion of S. aureus infections (36.1% vs. 16.7%; p < 0.001). The multilevel analysis revealed that neither dialysis nor cardiac surgery were independently associated with in-hospital mortality. Conclusions: Patients with ESRD and IE exhibit distinct clinical and microbiological characteristics compared to other IE patients. Additionally, they are less likely to undergo cardiac surgery and experience significantly higher in-hospital mortality rates. In ESRD patients with IE, neither dialysis treatment nor cardiac surgery were identified as independent risk factors for mortality.