Gómez-Ramírez Daniel, Olmos Carmen, Fernández-Pérez Cristina, Del Prado Náyade, Rosillo Nicolás, Bernal José Luis, Zulet Pablo, Vilacosta Isidre, Elola Francisco Javier
Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ Profesor Martín Lagos s/n, Madrid, 28040, Spain.
Facultad de Ciencias biomédicas y de la salud, Universidad Europea de Madrid, Madrid, Spain.
BMC Infect Dis. 2025 Apr 23;25(1):591. doi: 10.1186/s12879-025-10978-4.
Patients with end-stage renal disease (ESRD) have a higher risk of infective endocarditis (IE) and a worse prognosis associated with it. Our aim is to analyze the clinical characteristics and outcomes of patients with IE and ESRD in Spain, while exploring potential differences between patients undergoing dialysis and other patients with ESRD.
Retrospective observational population-based study analyzing 9,008 episodes of IE recorded between 2016 and 2019, using data from the Spanish Minimum Basic DataSet. Among these, 428 patients had ESRD, including 332 who were undergoing dialysis. A multivariable and multilevel logistic regression model was constructed to assess the association between various factors and in-hospital mortality in ESRD patients.
Compared to patients without ESRD, those with ESRD were younger, had more comorbidities, and showed a higher prevalence of infections caused by Staphylococcus aureus (31.8% vs. 18.4%; p < 0.001) and coagulase-negative staphylococci (19.2% vs. 14%; p = 0.006). ESRD patients also experienced septic shock more frequently as an in-hospital complication (12.1% vs. 8.9%; p = 0.007). Additionally, they underwent cardiac surgery less often (12.6% vs. 19.6%; p < 0.001) and had significantly higher in-hospital mortality rates (33.4% vs. 26.9%; p = 0.003) than patients without ESRD. Among ESRD patients, those undergoing dialysis had more comorbidities and a higher proportion of S. aureus infections (36.1% vs. 16.7%; p < 0.001). The multilevel analysis revealed that neither dialysis nor cardiac surgery were independently associated with in-hospital mortality.
Patients with ESRD and IE exhibit distinct clinical and microbiological characteristics compared to other IE patients. Additionally, they are less likely to undergo cardiac surgery and experience significantly higher in-hospital mortality rates. In ESRD patients with IE, neither dialysis treatment nor cardiac surgery were identified as independent risk factors for mortality.
终末期肾病（ESRD）患者发生感染性心内膜炎（IE）的风险更高，且与之相关的预后更差。我们的目的是分析西班牙IE合并ESRD患者的临床特征和预后，同时探讨透析患者与其他ESRD患者之间的潜在差异。
基于人群的回顾性观察研究，利用西班牙最低基本数据集分析2016年至2019年期间记录的9008例IE发作。其中，428例患者患有ESRD，包括332例正在接受透析的患者。构建多变量和多水平逻辑回归模型，以评估ESRD患者各种因素与住院死亡率之间的关联。
与非ESRD患者相比，ESRD患者更年轻，合并症更多，金黄色葡萄球菌（31.8%对18.4%；p<0.001）和凝固酶阴性葡萄球菌（19.2%对14%；p=0.006）引起的感染患病率更高。ESRD患者作为住院并发症发生感染性休克的频率也更高（12.1%对8.9%；p=0.007）。此外，他们接受心脏手术的频率较低（12.6%对19.6%；p<0.001），住院死亡率显著高于非ESRD患者（33.4%对26.9%；p=0.003）。在ESRD患者中，接受透析的患者合并症更多，金黄色葡萄球菌感染比例更高（36.1%对16.7%；p<0.001）。多水平分析显示，透析和心脏手术均与住院死亡率无独立关联。
与其他IE患者相比，ESRD合并IE患者表现出独特的临床和微生物学特征。此外，他们接受心脏手术的可能性较小，住院死亡率显著更高。在IE合并ESRD患者中，透析治疗和心脏手术均未被确定为死亡的独立危险因素。
