Infective endocarditis hospitalizations and outcomes in patients with end-stage kidney disease: a nationwide data-linkage study

Gallacher, P. J., McAllister, D. A. , Mills, N. L., Cruden, N. L., Shah, A. S.V. and Dhaun, N. (2021) Infective endocarditis hospitalizations and outcomes in patients with end-stage kidney disease: a nationwide data-linkage study. Journal of the American Heart Association, 10(19), e022002. (doi: 10.1161/JAHA.121.022002) (PMID:34581192) (PMCID:PMC8649148)

Abstract

Background: We investigated the clinical features, microbiology, and short‐ and long‐term outcomes of incident infective endocarditis (IE) hospitalizations in patients with end‐stage kidney disease (ESKD) requiring dialysis or with a kidney transplant over 25 years in Scotland. Methods and Results: In this retrospective, population‐based cohort study linking national hospitalization and mortality data, we identified patients with a history of ESKD and hospitalized with IE in Scotland between January 1, 1990 and December 31, 2014. From January 1, 2008, individual IE hospitalizations were additionally linked to national microbiology data. Multivariable logistic regression, adjusting for patient demographics and comorbidities, evaluated the association between ESKD and all‐cause death at 1 and 3 years. Of 7638 incident IE hospitalizations between 1990 and 2014, 2.8% (216/7638) occurred in 210 patients with ESKD and 97.2% (7422/7638) occurred in 7303 patients without ESKD. Positive findings from blood cultures were identified in 42% (950/2267) of incident IE hospitalizations from 2008. Staphylococcus aureus was isolated in 25.9% (21/81) and 12.8% (280/2186) of patients with and without ESKD, respectively (P=0.002). ESKD was associated with an increased odds of death at 1 (44.9% versus 31.4%; adjusted odds ratio [aOR], 2.47, 95% CI, 1.85–3.30;, P<0.001) and 3 years (63.9% versus 42.8%; aOR, 3.77; 95% CI, 2.79–5.12; P<0.001). Conclusions: IE is associated with a poor prognosis in patients with ESKD, especially in the longer term. Compared with patients without ESKD, patients with ESKD were twice as likely to die within 1 year, and 3 times as likely to die within 3 years of IE hospitalization.

• Item Type: Articles
• Additional Information: Gallacher is supported by a Medical Research Grant from the Mason Medical Research Foundation and a Clinical Research Training Fellowship (FS/ CRTF/20/24079) from the British Heart Foundation. Shah is supported by an Intermediate Clinical Research Fellowship (FS/19/17/34172) from the British Heart Foundation. Mills is supported by a Senior Clinical Research Fellowship (FS/16/14/32023) and a Research Excellence Award (RE/18/5/34216) from the British Heart Foundation. Dhaun is supported by a Senior Clinical Research Fellowship from the Chief Scientist Office (SCAF/19/02).
• Keywords: End‐stage renal disease, infective endocarditis, epidemiology.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McAllister, Professor David
• Authors: Gallacher, P. J., McAllister, D. A., Mills, N. L., Cruden, N. L., Shah, A. S.V., and Dhaun, N.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Journal of the American Heart Association
• Publisher: American Heart Association
• ISSN: 2047-9980
• ISSN (Online): 2047-9980
• Published Online: 28 September 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Journal of the American Heart Association 10(19): e022002
• Publisher Policy: Reproduced under a Creative Commons License