Abstract
Right-sided infective endocarditis (RSIE), classically associated with intravenous drug use or intracardiac devices, is considered a good-prognosis infective endocarditis (IE) form. However, predisposing factors and prognosis for “NODID” RSIE (NOt associated with cardiac Devices or Intravenous Drug use) remain unclear. The aim of this study was to evaluate predisposing factors and prognosis of NODID RSIE compared to other RSIE forms. A retrospective cohort study (January 2008–January 2019) was conducted in a reference center on 300 patients diagnosed with IE. Endocarditis-related events were defined as related to IE in mortality or open-heart surgery during follow-up. A review and meta-analysis of associated literature (January 2008-January 2019) were also performed. Fifty-seven patients presented RSIE (19%), 22 of which were NODID RSIE (39%). Use of intravascular catheters (23% vs 3%; p = 0.027) and congenital heart diseases (18% vs 0%; p = 0.019) were associated with NODID RSIE. This group had a higher in-hospital mortality (23% vs 3%; p = 0.027) and endocarditis-related event rates (41% vs 6%; p = 0.001) than non-NODID RSIE. Furthermore, NODID RSIE was independently associated with in-hospital endocarditis-related events (OR = 19.29; 95%CI:2.23–167.16; p = 0.007). Our meta-analysis evaluated four studies and identified 96 cases (30%) of NODID RSIE from 320 total RSIE cases. NODID RSIE patients demonstrated higher in-hospital mortality (RR = 2.81; 95%CI:1.61–4.90; p < 0.001; I2 = 0.0%) and necessity of open-heart surgery (RR = 13.89; 95%CI:4.14–46.60; p < 0.001; I2 = 0.0%) than non-NODID RSIE cases. Our study suggests that NODID RSIE has the highest endocarditis-related event rate and in-hospital mortality among RSIE cases and therefore should not be considered a good-prognosis IE.
Highlights
The benign in-hospital course of Right-sided infective endocarditis (RSIE) is mainly based on youth and low comorbidities of IVDU cases and good results from combined antimicrobial treatment and hardware removal in patients with cardiac devices[7,8,9,10]
not associated with cardiac devices or IVDU (NODID) RSIE cases presented higher in-hospital mortality (RR = 2.81; 95%confidence intervals (CI): 1.61–4.90; p < 0.001; www.nature.com/scientificreports right-sided infective endocarditis (RSIE) cases during hospitalization from four studies
This study demonstrates that NODID RSIE, without association to IVDU or cardiac devices, has the worst clinical prognosis among RSIEwith in-hospital mortality of >20%
Summary
The benign in-hospital course of RSIE is mainly based on youth and low comorbidities of IVDU cases and good results from combined antimicrobial treatment and hardware removal in patients with cardiac devices[7,8,9,10]. In the past decade a new group of RSIE not associated with cardiac devices or IVDU (NODID) has been described,but its prognosis and predisposing factors are not wellestablished[9,11,12,13,14]. This study determined the clinical evolution of NODID RSIE in a recent cohort of IE patients and established thepossible predisposing factors for this group.
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