Abstract 13617: Trends and Outcomes of Endocarditis in Patients Undergoing Hemodialysis in Contemporary US Population From 2016-18

Abstract

Background: With increasing valvular interventions, the incidence of endocarditis in patients on chronic dialysis is significantly increasing. Therefore, we aimed to investigate and compare the contemporary outcomes and trends of endocarditis in patients receiving dialysis. Methods: All hospitalizations with a primary diagnosis of endocarditis between 2016 and 2018 identified in the Nationwide Inpatient Sample were categorized into those with or without chronic dialysis. The primary outcomes were inpatient mortality. Survey techniques were used to do comparative analyses using Stata. Results: Of 53,950 endocarditis hospitalizations that met inclusion criteria, 6,075(11.26%) had endocarditis with chronic dialysis. In-hospital mortality in endocarditis patients with and without chronic dialysis was 18.8% vs. 7.7%. Hospitalizations for endocarditis with chronic dialysis were associated with higher prevalence of diabetes (16.7% vs. 9.8%), hypertension (27.7% vs. 21.2%), coagulopathy (28.7% vs. 19.3%), sepsis (59.3% vs. 43.7%), liver disease (17.2% vs. 11.4%), congestive heart failure (54.5% vs. 39.6%) and renal failure (88.8% vs. 24.0%) as compared with endocarditis without chronic dialysis, all p-values <0.05. Hospitalizations for endocarditis with chronic dialysis was seen less likely in patients with valvular disease (54.9% vs. 67.3%), solid tumor without metastasis (2.2% vs. 4.2%), and smoking (15.2% vs. 25.7%), all p-values <0.05. In a multivariable logistic regression model, the patients with chronic dialysis were two times likely to die from endocarditis OR 1.97 (1.66-2.34; p-value <0.001). Older age, liver disease, and higher elixhauser score were the independent predictors of in-hospital mortality in patients with chronic dialysis who had endocarditis. Conclusions: The prevalence of chronic dialysis has been increasing in patients with endocarditis and it contributes to significant complications including sepsis and mortality.