Abstract: TH-PO899

Mortality Risk and Cause of Death Following Staphylococcus aureus Endocarditis in a Danish Hemodialysis Population

Session Information

  • Dialysis: Infection
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 610 Dialysis: Infection

Authors

  • Chaudry, Mavish, Department of Cardiology, Copenhagen, Denmark
  • Bruun, Niels Eske, Herlev-Gentofte Hospital, Hellerup, Denmark
  • Gislason, Gunnar, Gentofte Hospital, Copenhagen, Denmark
  • Kamper, Anne-Lise, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
  • Rix, Marianne, Rigshospitalet, Copenhagen, Denmark
  • Dahl, Anders, Gentote University Hospital, Hellerup, Denmark
  • Lauridsen, Trine K, Copenhagen University Hospital, Charlottenlund, Denmark
  • Oestergaard, Louise Bruun, Aalborg University, Aalborg, Denmark
  • Hassager, Christian, Rigshospitalet, Copenhagen, Denmark
  • Torp-Pedersen, Christian, Aalborg University Hospital, Aalborg, Denmark
Background

Staphylococcus aureus endocarditis has increased over the past decades and is a contributing factor to high mortality and morbidity. Outcome data are sparse. The study aimed to investigate causes and risk factors of mortality subsequent to staphylococcus aureus (S. aureus) IE in a hemodialysis- and a non-hemodialysis population.

Methods

S. aureus IE in hemodialysis patients was identified in The Danish National Registry on Regular Dialysis and Transplantation and The Danish National Patient Registry, and in non-hemodialysis patients in The East Danish Database on Endocarditis which contains data on consecutive patients with S. aureus IE from tertiary centres in the eastern part of Denmark. Independent risk factors of outcome were identified in multivariable Cox regression models.

Results

The cohorts of S. aureus IE included 121 hemodialysis patients and 197 non-hemodialysis patients from the period 1996-2012 and 2002-2012, respectively. The all-cause in-hospital mortality was 22.3% in hemodialysis- and 24.8% in non-hemodialysis patients. At one-year follow-up the all-cause mortality, excluding in-hospital mortality, was higher in hemodialysis patients 26.4% compared to non-hemodialysis patients 15.2% (p=0.017).
In hemodialysis- and non-hemodialysis patients, the cardiovascular in-hospital mortality was 20.7% and 21.7% and one-year mortality, excluding in-hospital mortality, was 21.5% and 12.2% (p=0.030), respectively. In patients with S. aureus IE, hemodialysis was associated with an increased risk of all-cause mortality at >74 days after admission with S. aureus IE with a hazard ratio of 2.71 (95% CI 1.78-4.16). Age and diabetes mellitus were identified as independent risk factors of all-cause mortality. Hemodialysis treatment was also associated with an increased risk of cardiovascular death at >56 days after admission with a hazard ratio of 2.76 (95% CI 1.74-4.40).

Conclusion

In hemodialysis patients, the short-term in-hospital mortality rates are similar to the non-hemodialysis population whereas the long-term mortality rates are markedly increased in the hemodialysis population. Further investigations are needed to identify direct IE related reasons for these findings.