Contemporary Outcomes and Predictors of Inpatient Mortality for Infective Endocarditis Occurring in Renal Transplant Recipients in the United States

Abstract

Renal transplant (RT) recipients are susceptible to infections because of immunosuppression. The literature regarding the epidemiology and outcomes of infective endocarditis (IE) in RT recipients is limited. We analyzed the National Inpatient Sample in the United States to study IE in RT and identify risk factors for inpatient mortality and IE development in RT patients. All patients ≥18years who had IE with and without RT between 2007 and 2019 were identified from the National Inpatient Sample. The demographics, co-morbidities, length of stay, hospital costs, and mortality of IE patients with RT were compared with IE patients without RT. Predictors of inpatient mortality for RT recipients with IE were analyzed. Between 2007 and 2019, there were 777,245 hospitalizations for IE, of which 3,782 had RT. The IE in RT cohort was younger than the general IE population and had higher proportions of males, non-White races, and Hispanic ethnicity, and higher burden of co-morbidities, but similar inpatient mortality rates. On multivariate analysis, Staphylococcal IE (adjusted odds ratio [aOR]2.26, 95% confidence interval [CI] 1.2 to 4.3, p=0.015), stroke (aOR6.4, 95% CI 2.7 to 15.3, p<0.001), anemia (aOR2.3, 95% CI 1.3 to 4.0, p=0.004), and shock (aOR6.3, 95% CI 3.3 to 11.9, p<0.001) were associated with greater inpatient mortality, whereas Streptococcal endocarditis (aOR0.37, 95% CI 0.1 to 0.9, p=0.038) was associated with lower inpatient mortality. In conclusion, RT patients with IE were younger and had more severe co-morbidities compared with IE patients without RT. Staphylococcal IE, presence of shock and stroke worsened the prognosis in these patients.