Post-surgical outcomes in infective endocarditis patients with liver disease: nationwide propensity-match analysis

Abstract

Abstract Introduction Surgery remains the definitive treatment for persistent infective endocarditis (IE). Age, renal dysfunction and diabetes mellitus are few amongst the many associated with increased post-surgical mortality. Liver dysfunction is a common entity seen in patients with IE. Data on post-surgical sequelae in patients with IE and liver disease is lacking. Method We performed a retrospective cross-sectional analysis of all adult (age>18 years) admissions with a discharge diagnosis of acute or sub-acute IE using the 2016 National Inpatient Sample (NIS). IE patients undergoing valve replacement or repair were identified and divided into two groups based on the presence or absence of liver disease. Propensity score matching was performed to control for confounders such as diabetes, age, smoking among others. Odds of in-hospital mortality, cardiogenic shock, and acute kidney injury were calculated using multivariate logistic regression analysis. IE patients without liver disease undergoing valve surgery were selected as the reference population. Results We identified a total of 9,822 IE related admissions in the 2016 NIS. Amongst all IE admissions, 11.7% (n=1,158) had either valve replacement or repair surgery performed. After using propensity scores for 1 to 1 matching 16.8% of patients (n=195) who had concomitant liver disease were compared with 195 patients without liver disease. In-hospital mortality was significantly higher in patients with hepatic impairment (14.3% vs 0.51%, p=0.004). Patients with liver disease also had higher odds of concurrent cardiogenic shock (OR=9.35, 95% CI=3.01–29.15, p=0.001), acute kidney injury (OR=2.13, 95% CI=1.15–3.93, p=0.01), and thrombocytopenia (OR=2.29, 95% CI=1.13–4.61, p=0.02). Discussion The presence of liver disease in the setting of IE, in patients undergoing valvular surgery significantly increases the morbidity and mortality post-operatively. Functional status of the liver should be considered in addition to the commonly used tools for cardiac operative risk evaluation. Funding Acknowledgement Type of funding source: None