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

Abstract

Shuh-Kuan Liau,1 George Kuo,1 Chao-Yu Chen,1 Yu-Cheng Chen,2 Yueh-An Lu,1 Yu-Jr Lin,3 Cheng-Chieh Hung,1 Ya-Chung Tian,1 Hsiang-Hao Hsu1 1Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 2Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; 3Research Services Center for Health Information from Chang Gung University, Taoyuan, TaiwanCorrespondence: Hsiang-Hao HsuDepartment of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, No. 5 Fu-Shin Street, Kweishan, Taoyuan, 333, TaiwanTel [phone] ext. 8181Fax [phone]Email [email protected]: 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 three-year mortality.Keywords: infective endocarditis, chronic dialysis, end-stage kidney disease, blood-stream infection, infectious disease, sepsis

Keywords

• infective endocarditis
• chronic dialysis
• end-stage kidney disease
• blood-stream infection
• infectious disease
• sepsis