Left-sided infective endocarditis in patients with liver cirrhosis

• DOI: 10.1016/j.jinf.2015.09.005
• Publication Date: 2015-09-25T22:40:38Z
• Authors: 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-Gon...; Fernando Fernánde...; Marian Noureddine; Gabriel Rosas; Javier de la Torr...; José Aramendi; Elena Bereciartua; María Victoria Boado; Marta Campaña Lázaro; Juan José Goiti; José Luis Hernández; José Ramón Iruret...; Josu Irurzun Zuaz...; Leire López-Soria; Miguel Montejo; Pedro María Pérez; Regino Rodríguez; Roberto Voces; Mª Victoria Garcí...; Manuel Márquez So...; Isabel Rodríguez ...; Gemma Sanchez Espín; Juan Otero; Ana María Cuende; Eduardo Gaminde; Pedro Idígoras; José Antonio Irib...; Alberto Izaguirre...; Carlos Reviejo; Tomás Echeverría; Eduardo Gaminde; Ana Fuertes; Rafael Carrasco; Vicente Climent; Patricio Llamas; Esperanza Merino; Joaquín Plazas; Sergio Reus; Nemesio Álvarez; María del Mar Car...; Laura Castelo; José Cuenca; Pedro Llinares; Enrique Miguez Rey; María Rodríguez Mayo; Dolores Sousa; Mª Carmen Zúñiga; Francisco Javier ...; J.M. Lomas Cabezas; Mª del Mar Alonso; Beatriz Castro; Dácil García Marrero; Mª del Carmen Durán; Mª Antonia Miguel...; Juan La Calzada; Ibrahim Nassar; José Mª Reguera I...; Víctor Asensi Álv...; Carlos Costas; Jesús de la Hera; Jonnathan Fernánd...; José Manuel Garcí...; Lisardo Iglesias ...; José López Menéndez; Pilar Mencia Bajo; Carlos Morales; Alfonso Moreno To...; Carmen Palomo; Begoña Paya Martínez; Ángeles Rodríguez; Raquel Rodríguez ...; Mauricio Telenti; Manuel Almela; Yolanda Armero; Manuel Azqueta; Ximena Castañeda; Carlos Cervera; Carlos Falces; Cristina García-d...; José M. Gatell; Jaume Llopis; Francesc Marco; Carlos A. Mestres; Asunción Moreno; Salvador Ninot; José Ramírez; Marta Sitges; Carlos Paré; Juan M. Pericás; Javier Bermejo; Emilio Bouza; Viviana de Egea; Alia Eworo; Ana Fernández Cruz; Mª Eugenia García...; Marcela González ...; Víctor González R...; Martha Kestler He...; Mercedes Marín; Manuel Martínez-S...; Mª Cruz Menárguez; Hugo Rodríguez-Ab...; Marta Rodríguez-C...; Jorge Rodríguez Roda; Blanca Pinilla; Ángel Pinto; Maricela Valerio; Eduardo Verde Moreno; Isabel Antorrena; Mar Moreno; José Ramón Paño; Sandra Rosillo; María Romero; Araceli Saldaña; Carlos Armiñanzas...; Ana Arnaiz; José Berrazueta; Sara Bellisco; Manuel Cobo Belau...; Raquel Durán; Concepción Fariña...; Carlos Fernández ...; Rubén Gómez Izqui...; Claudia González ...; José Gutiérrez Díez; Rafael Martín Durán; Marcos Pajarón; José Antonio Parra; Ramón Teira; Jesús Zarauza; Pablo García Pavía; Jesús González; Beatriz Orden; Antonio Ramos; Elena Rodríguez G...; Tomasa Centella; José Hermida; José Moya; Pilar Martínez; Enrique Navas; Enrique Oliva; Alejandro del Río; Soledad Ruiz; Antonio de Castro; Marina de Cueto; Pastora Gallego; Jesús Rodríguez Baño; José Antonio Lepe; Rafael Luque Márquez; Encarnación Gutié...; Julia Eslava Galán; Luis Javier Alonso; José Manuel Azcon...; José Ramón Blanco; Lara García; José Antonio Oteo; Natividad de Benito; Mercé Gurguí; Cristina Pacho; Roser Pericas; Guillem Pons; M. Álvarez; A.L. Fernández; Amparo Martínez; A. Prieto; Benito Regueiro; E. Tijeira; Marino Vega; Andrés Canut Blasco; José Cordo Mollar; Juan Carlos Gainz...; Oscar García Uriarte; Alejandro Martín ...; Zuriñe Ortiz de Z...; José Antonio Urtu...; Mª Belén Nacle; Antonio Sánchez; Luis Vallejo; José Mª Arribas Leal; Elisa García Vázquez; Alicia Hernández ...; Joaquín Ruiz Gómez; Gonzalo de la Mor...; Ángel Alonso; Javier Aramburu; Felicitas Elena C...; Anai Moreno Rodrí...; Paola Tarabini-Ca...; Eva Heredero Gálvez; Carolina Maicas B...; Mª Antonia Sepúlveda; Eva Cascales Alcolea; Pilar Egea Serrano; José Joaquín Hern...
• Keywords: Infective Endocarditis

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.Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals.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.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.