Elodie Curlier1, Bruno Hoen1, François Alla2, Christine Selton-Suty3, Lucile Schubel4, Thanh Doco-Lecompte5, Laetitia Minary2, Marie-Line Erpelding2, Xavier Duval6, Catherine Chirouze7. 1. UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté, Besançon, France Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon, France Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537 Pointe-à-Pitre, Guadeloupe, France Centre Hospitalier Universitaire de Pointe-à-Pitre, CIC-EC (CIE 802), Service de Maladies Infectieuses et Tropicales, Pointe-à-Pitre, France. 2. INSERM, CIC-EC, CIE6, F-54000, Nancy, France Epidémiologie et Evaluation Cliniques, Pôle S2R, F-54000, Centre Hospitalier Universitaire, Nancy, France. 3. Service de Cardiologie, Centre Hospitalier Universitaire, Nancy, France. 4. Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon, France. 5. Service de Maladies Infectieuses, Centre Hospitalier Universitaire, Nancy, France. 6. Inserm U738, Université Paris Diderot, Paris 7, Faculté de Médecine Bichat, Paris, France Inserm CIC 007, AP-HP, Centre Hospitalier Universitaire Bichat, Paris, France. 7. UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté, Besançon, France Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon, France.
Abstract
OBJECTIVE: Whether sex-related differences in the prognosis of infective endocarditis (IE) are due to differences in disease severity or comorbid patterns, physiological specificities or a treatment indication bias is unclear. We conducted an analysis of the pooled database of two population-based cohorts of IE to reassess the relationships between sex, early valve surgery (EVS) and outcome in patients with IE. METHODS: Demographic and baseline characteristics, complications and outcome were compared in men and women with Duke-definite left-sided IE. A propensity model for EVS was constructed using multivariate logistic regression. Factors associated with 1-year mortality were identified using multivariate Cox models adjusted for EVS factors. RESULTS: The study population included 466 (75%) men and 154 (25%) women. Compared with men, women were older (p=0.005), were more often on haemodialysis (p=0.04), more often had a mitral valve IE (50.0% vs 35.8%, p=0.02), less often developed a septic shock (p=0.05), less often underwent EVS (p=0.001) yet had comparable inhospital mortality rates (20.1% vs 20.0%, p=0.96) and similar 1-year survival probability (logrank p=0.68). Female sex was neither associated with EVS (OR 0.76 (95% CI 0.49 to 1.16)) nor mortality (HR 1.17 (95% CI 0.80 to 1.69)). However EVS was associated with an increased risk of death in women in the early postoperative period (HR 8.72 (95% CI 3.42 to 22.24), p=<0.0001). CONCLUSIONS: Women underwent EVS less often than men. However female sex was independently associated with neither EVS nor 1-year mortality. The reasons for a higher risk of early postoperative mortality in women must still be elucidated. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVE: Whether sex-related differences in the prognosis of infective endocarditis (IE) are due to differences in disease severity or comorbid patterns, physiological specificities or a treatment indication bias is unclear. We conducted an analysis of the pooled database of two population-based cohorts of IE to reassess the relationships between sex, early valve surgery (EVS) and outcome in patients with IE. METHODS: Demographic and baseline characteristics, complications and outcome were compared in men and women with Duke-definite left-sided IE. A propensity model for EVS was constructed using multivariate logistic regression. Factors associated with 1-year mortality were identified using multivariate Cox models adjusted for EVS factors. RESULTS: The study population included 466 (75%) men and 154 (25%) women. Compared with men, women were older (p=0.005), were more often on haemodialysis (p=0.04), more often had a mitral valve IE (50.0% vs 35.8%, p=0.02), less often developed a septic shock (p=0.05), less often underwent EVS (p=0.001) yet had comparable inhospital mortality rates (20.1% vs 20.0%, p=0.96) and similar 1-year survival probability (logrank p=0.68). Female sex was neither associated with EVS (OR 0.76 (95% CI 0.49 to 1.16)) nor mortality (HR 1.17 (95% CI 0.80 to 1.69)). However EVS was associated with an increased risk of death in women in the early postoperative period (HR 8.72 (95% CI 3.42 to 22.24), p=<0.0001). CONCLUSIONS:Women underwent EVS less often than men. However female sex was independently associated with neither EVS nor 1-year mortality. The reasons for a higher risk of early postoperative mortality in women must still be elucidated. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Ruchi Bhandari; Shabnam Tiwari; Talia Alexander; Frank H Annie; Umar Kaleem; Affan Irfan; Sudarshan Balla; R Constance Wiener; Chris Cook; Aravinda Nanjundappa; Mark Bates; Ellen Thompson; Gordon S Smith; Judith Feinberg; Melanie A Fisher Journal: J Clin Med Date: 2022-06-18 Impact factor: 4.964