Cirrhosis Increases Morbidity and Mortality Among Infective Endocarditis Patients: A National Cohort Study

Introduction: Cirrhosis is associated with high morbidity and mortality. This study aims to understand the incidence, morbidity, and mortality of cirrhosis among Infective Endocarditis (IE) patients. Methods: The patient cohort was extracted from Nationwide Inpatient Sample October 1st, 2015, to December 31st, 2018, using International Classification of Disease 10 (ICD-10) codes for cirrhosis, IE, and various comorbidities/procedures. We estimated the incidence, in-hospital mortality, and predictors of mortality among patients who developed IE during their hospitalization stratified by no cirrhosis, compensated cirrhosis and decompensated cirrhosis. Multivariate regression model was generated using demographic, hospital-level characteristics, and comorbidities to obtain the adjusted odds ratios (aOR). Results: A total of 37,634 patients with IE were identified over the study period. Overall, in-hospital mortality rate was 10.14%. Mean length of stay was 14.3 days. There was a statistical difference among mean age within the subgroups (p < 0.001): no cirrhosis (54.8 years), compensated cirrhosis (57.4 years), decompensated cirrhosis (57.2 years). Patients with compensated cirrhosis (34.3%) and decompensated cirrhosis (33.2%) were significantly less likely (p < 0.001) to be females than patients without cirrhosis (41.9%). Stratified outcomes are shown in Table 1. There were significantly elevated rates of mortality, intensive care unit (ICU) admissions, and new-onset dialysis in the decompensated cirrhosis patient population. Patients with compensated and decompensated cirrhosis were less likely to receive surgical interventions in the form of valvular repair. Conclusion: We conducted a retrospective study which demonstrated that IE patients with decompensated cirrhosis were twice as likely to have inpatient mortality, increased ICU admissions, and increased need for dialysis compared to those without cirrhosis. This is likely explained by the potential for distributive shock, associated immunocompromised state, coagulopathy and renal dysfunction. Surgical intervention is lower in all cirrhosis patients, likely due to the increased perioperative cardiovascular risk. IE patient population represents a high-risk group, and the presence of cirrhosis as a comorbidity significantly worsens patient outcomes. Further studies are warranted to determine whether early referral to liver specialists and spontaneous bacterial peritonitis prophylaxis improves outcomes of cirrhosis in IE patients.Table 1.: APRI and FIB4 in patients treated with Entecavir, Viread, and Vemlidy. Df= degrees of freedom, F= F-statistics, SE = standard error, η2p = Partial η2.