ODP066 Impact of Comorbid Adrenal Insufficiency on Outcomes of Infective Endocarditis Hospitalizations

Abstract

Abstract Background Adrenocortical integrity is vital to mounting an appropriate response to a potentially deleterious endovascular infection such as infectious endocarditis. Likewise, adrenocortical hormones affect how cytokine storms lead to secondhand injuries that complicate sepsis. Data on the clinical outcomes of infective endocarditis in patients with adrenal insufficiency is limited and thus our attempt to study this topic was perhaps a worthwhile venture. Method: A retrospective cohort study was designed using data obtained from the 2016 to 2018 combined National Inpatient Sample (NIS) database. Adult patients (age >18) admitted with a principal diagnosis of acute and subacute infective endocarditis were identified using the international diseases classification code, tenth revision (ICD-10). They were then stratified into two cohorts based on the presence of adrenal insufficiency. Primary outcomes assessed were, mortality, length of stay (LOS) and total hospital charge. Secondary outcomes included septic shock, embolic stroke, cardiogenic shock, and septic arterial embolization. Multivariate linear and logistic regressions were used to adjust for confounders. Results There was a total of 36,669.97 adult hospitalizations for infective endocarditis, among which 0.67% had a secondary diagnosis of adrenal insufficiency. The presence of adrenal insufficiency led to an increased length of stay (19.66 days vs 13. 05 days, adjusted mean difference of 7.17 days, 95%CI: 1.41 to 12.92 days, p: 0. 015) and an increased total charge (342,312.3 USD vs 147,887.6 USD, adjusted mean difference: 189,447.6 USD, 95%CI: 32,509.7USD to 346,385.5 USD, p: 0. 018) compared with patients without adrenal insufficiency. There was no significant difference in the odds of mortality between the two groups (4. 00% vs 4. 01%, AOR: 0.87, 95% CI: 0.99 to 7.57, p: 0.898). Similarly, other secondary clinical outcomes including septic shock, cardiogenic shock, septic arterial embolization, and embolic strokes were not different between the two cohort groups. Conclusion The presence of adrenal insufficiency among patients admitted with infective endocarditis led to an increased length of stay and a commensurate increased total charge. However, it did not significantly impact the outcomes in terms of mortality, rate of septic shock, cardiogenic shock, septic arterial embolization, or embolic strokes. Presentation: No date and time listed