Left-sided infective endocarditis in patients with liver cirrhosis

J. Ruiz-Morales, R. Ivanova-Georgieva, N. Fernández-Hidalgo, E. García-Cabrera, Jose M. Miró, P. Muñoz, B. Almirante, A. Plata-Ciézar, V. González-Ramallo, J. Gálvez-Acebal, M. C. Fariñas, J. M. Bravo-Ferrer, M. A. Goenaga-Sánchez, C. Hidalgo-Tenorio, J. Goikoetxea-Agirre, A. de Alarcón-González, Fernando Fernández Sánchez, Marian Noureddine, Gabriel Rosas, Javier de la Torre LimaAne Josune Goikoetxea-Agirre, José Aramendi, Elena Bereciartua, María Victoria Boado, Marta Campaña Lázaro, Juan José Goiti, José Luis Hernández, José Ramón Iruretagoyena, Josu Irurzun Zuazabal, Leire López-Soria, Miguel Montejo, Pedro María Pérez, Regino Rodríguez, Roberto Voces, Josefa Ruiz Morales, Radka Ivanova Georgieva, M. Victoria García López, Manuel Márquez Solero, Isabel Rodríguez Bailón, Gemma Sanchez Espín, Juan Otero, Miguel Angel Goenaga Sánchez, Ana María Cuende, Eduardo Gaminde, Pedro Idígoras, José Antonio Iribarren, Alberto Izaguirre Yarza, Carlos Reviejo, Tomás Echeverría, Ana Fuertes, Rafael Carrasco, Vicente Climent, Patricio Llamas, Esperanza Merino, Joaquín Plazas, Sergio Reus, Jose María Bravo Ferrer, Nemesio álvarez, María del Mar Carmona, Laura Castelo, José Cuenca, Pedro Llinares, Enrique Miguez Rey, María Rodríguez Mayo, Dolores Sousa, M. Carmen Zúñiga, Francisco Javier Martínez-Marcos, J. M. Lomas Cabezas, M. del Mar Alonso, Beatriz Castro, Dácil García Marrero, M. del Carmen Durán, M. Antonia Miguel Gómez, Juan La Calzada, Ibrahim Nassar, Antonio Plata Ciézar, José M. Reguera Iglesias, Víctor Asensi álvarez, Carlos Costas, Jesús de la Hera, Jonnathan Fernández Suárez, José Manuel García Ruiz, Lisardo Iglesias Fraile, José López Menéndez, Pilar Mencia Bajo, Carlos Morales, Alfonso Moreno Torrico, Carmen Palomo, Begoña Paya Martínez, ángeles Rodríguez, Raquel Rodríguez García, Mauricio Telenti, Manuel Almela, Yolanda Armero, Manuel Azqueta, Ximena Castañeda, Carlos Cervera, Carlos Falces, Cristina García-de-la-Maria, José M. Gatell

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8 Citations (Scopus)

Abstract

© 2015 The British Infection Association. Objective: To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery. Methods: Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals. Results: A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p < 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23-1.85; p < 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery. Conclusions: Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.
Original languageEnglish
Pages (from-to)627-641
JournalJournal of Infection
Volume71
Issue number6
DOIs
Publication statusPublished - 1 Jan 2015

Keywords

  • Left-sided infectious endocarditis
  • Liver cirrhosis
  • Prognostic
  • Risk stratification
  • Surgery

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