Infective endocarditis and solid organ transplantation: Only worse outcomes during initial transplantation hospitalization

Am Heart J. 2021 Oct:240:63-72. doi: 10.1016/j.ahj.2021.06.007. Epub 2021 Jun 20.

Abstract

Background: The epidemiology, and outcome of infective endocarditis (IE) among solid organ transplant (SOT) recipients is unknown.

Methods: We used data from the 2013-2018 Nationwide Readmissions Database (NRD). IE- and SOT-associated hospitalizations were identified using diagnosis and procedure codes. Outcomes included inpatient mortality, length of stay, and inpatient costs. Adjusted analyses were performed using weighted regression models.

Results: A total of 99,052 IE-associated hospitalizations, corresponding to a weighted national estimate of 193,164, were included for analysis. Of these, 794 (weighted n = 1,574) were associated with transplant history (SOT-IE). Mortality was not significantly different between SOT-IE and non-SOT-IE (17.2% vs. 15.8%, adjusted relative risk [aRR]: 0.86, 95% confidence interval [CI] [0.71, 1.03]), and fewer SOT-IE patients underwent valve repair or replacement than non-SOT-IE (12.5% vs. 16.2%, aRR 0.82, 95% CI [0.71, 0.95]). We then compared outcomes of patients diagnosed with IE during their index transplant hospitalization (index-SOT-IE) to patients without IE during their transplant hospitalization (index-SOT). Index-SOT-IE occurred most frequently among heart transplant recipients (45.1%), and was associated with greater mortality (27.1% vs. 2.3%, aRR 6.07, 95% CI [3.32, 11.11]).

Conclusion: Dual diagnosis of SOT and IE was associated with worse outcomes among SOT recipients during index hospitalization, but not overall among patients with IE.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Databases, Factual
  • Endocarditis / etiology*
  • Female
  • Hospital Costs
  • Hospital Mortality
  • Hospitalization / economics
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Organ Transplantation / adverse effects*
  • Organ Transplantation / mortality
  • Postoperative Complications
  • Regression Analysis
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • United States