Predictors of Surgical Intervention in Dialysis Patients With Infective Endocarditis

Author:

Woller III John A12,Walsh Victoria L341,Robichaux Chad41,Thourani Vinod H5,Jacob Jesse T341

Affiliation:

1. Emory University School of Medicine, Atlanta, Georgia

2. Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia

3. Division of Infectious Diseases, Atlanta, Georgia

4. Department of Medicine, Atlanta, Georgia

5. Department of Cardiac Surgery, MedStar Heart & Vascular Institute, MedStar Health, Columbia, Maryland

Abstract

Abstract Background The use of valve surgery for infective endocarditis (IE) in end-stage renal disease (ESRD) patients may be different than in the general population. We assessed predictors of early surgery in ESRD patients with IE. Methods We conducted a retrospective cohort study among dialysis patients with left-sided IE between 2005 and 2015. Indications for surgery were based on current endocarditis guidelines. Patients were categorized as early valve replacement surgery or delayed/no surgery. We used logistic regression to determine independent predictors of early surgery. Results Among 229 patients, 67 (29.3%) underwent early surgery. New congestive heart failure was the only high level of evidence indication independently associated with early surgery (odds ratio [OR], 12.1; 95% confidence interval [CI], 3.4–43.6). Transfer from outside hospital (OR, 5.4; 95% CI, 2.2–13.3), valve rupture (OR, 6.9; 95% CI, 2.6–17.9), coagulase-negative staphylococcus etiology (OR, 3.8; 95% CI, 1.4–10.6), and presence of any low level of evidence indication (OR, 5.9; 95% CI, 2.2–15.5) predicted early surgery. Preexisting valve disease (OR, 0.31; 95% CI, 0.12–0.82) and surgical contraindications (OR, 0.05; 95% CI, 0.005–0.4) predicted nonsurgical treatment. Conclusions Among ESRD patients with IE, most surgical indications are not predictive of early surgery.

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Oncology

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