[Infective endocarditis in patients with chronic liver disease: clinical and prognostic assessment].
OBJECTIVE
Chronic liver disease increases the susceptibility to bacterial infections and infective endocarditis. Our aim was to determine the clinical and microbiological features and the prognosis in patients with chronic liver disease who also had infective endocarditis.


METHODS
One hundred and seventy-four consecutive inpatients at our institution were recruited and followed. Thirty of them had chronic liver disease. Clinical, microbiological and echocardiographic variables were analyzed and, in some cases, histological variables were also recorded.


RESULTS
Patients with chronic liver disease were younger (36 11 vs 54 18 years; p < 0.01) and had a larger proportion of intravenous drug users (73 vs 16%; p < 0.01), HIV infection (47 vs 10%; p < 0.01), right valve involvement and spleen enlargement, but heart failure appeared less often (7 vs 34%; p = 0.003). Thirty percent of the patients with and 51% of patients without chronic liver disease underwent surgery for infective endocarditis. Total mortality among patients with and without chronic liver disease was 40% and 31%, respectively. After adjustment for age and for the incidence of congestive heart failure, chronic liver disease doubled mid-term mortality with a RR = 2.45 (p = 0.015).


CONCLUSIONS
Chronic liver disease has a significant impact on the prognosis in patients with infective endocarditis, and these patients should therefore be considered a high risk group.
Pérez De Isla
Leopoldo
L
Laboratorio de Ecocardiografía. Hospital Clínico San Carlos. Madrid. España.
Zamorano
José Luis
JL
Almería
Carlos
C
Rodrigo
José Luis
JL
Piedra
Itziar
I
Aubele
Adalía
A
Mataix
Luis
L
Herrera
Dionisio
D
Macaya
Carlos
C
D000328:Adult; D002908:Chronic Disease; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors