title: Relationships between sex, early valve surgery and mortality in patients with left-sided infective endocarditis analysed in a population-based cohort study.
abstract: OBJECTIVE
  Whether sex-related differences in the prognosis of infective endocarditis (IE) are due to differences in disease severity or comorbid patterns, physiological specificities or a treatment indication bias is unclear. We conducted an analysis of the pooled database of two population-based cohorts of IE to reassess the relationships between sex, early valve surgery (EVS) and outcome in patients with IE.
  
  
  METHODS
  Demographic and baseline characteristics, complications and outcome were compared in men and women with Duke-definite left-sided IE. A propensity model for EVS was constructed using multivariate logistic regression. Factors associated with 1-year mortality were identified using multivariate Cox models adjusted for EVS factors.
  
  
  RESULTS
  The study population included 466 (75%) men and 154 (25%) women. Compared with men, women were older (p=0.005), were more often on haemodialysis (p=0.04), more often had a mitral valve IE (50.0% vs 35.8%, p=0.02), less often developed a septic shock (p=0.05), less often underwent EVS (p=0.001) yet had comparable inhospital mortality rates (20.1% vs 20.0%, p=0.96) and similar 1-year survival probability (logrank p=0.68). Female sex was neither associated with EVS (OR 0.76 (95% CI 0.49 to 1.16)) nor mortality (HR 1.17 (95% CI 0.80 to 1.69)). However EVS was associated with an increased risk of death in women in the early postoperative period (HR 8.72 (95% CI 3.42 to 22.24), p=<0.0001).
  
  
  CONCLUSIONS
  Women underwent EVS less often than men. However female sex was independently associated with neither EVS nor 1-year mortality. The reasons for a higher risk of early postoperative mortality in women must still be elucidated.
authors.affiliation: UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté, Besançon, France Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon, France Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537 Pointe-à-Pitre, Guadeloupe, France Centre Hospitalier Universitaire de Pointe-à-Pitre, CIC-EC (CIE 802), Service de Maladies Infectieuses et Tropicales, Pointe-à-Pitre, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Curlier
authors.affiliation: UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté, Besançon, France Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon, France Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537 Pointe-à-Pitre, Guadeloupe, France Centre Hospitalier Universitaire de Pointe-à-Pitre, CIC-EC (CIE 802), Service de Maladies Infectieuses et Tropicales, Pointe-à-Pitre, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
authors.affiliation: INSERM, CIC-EC, CIE6, F-54000, Nancy, France Epidémiologie et Evaluation Cliniques, Pôle S2R, F-54000, Centre Hospitalier Universitaire, Nancy, France.
authors.forename: François
authors.initials: F
authors.lastname: Alla
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire, Nancy, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Selton-Suty
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon, France.
authors.forename: Lucile
authors.initials: L
authors.lastname: Schubel
authors.affiliation: Service de Maladies Infectieuses, Centre Hospitalier Universitaire, Nancy, France.
authors.forename: Thanh
authors.initials: T
authors.lastname: Doco-Lecompte
authors.affiliation: INSERM, CIC-EC, CIE6, F-54000, Nancy, France Epidémiologie et Evaluation Cliniques, Pôle S2R, F-54000, Centre Hospitalier Universitaire, Nancy, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Minary
authors.affiliation: INSERM, CIC-EC, CIE6, F-54000, Nancy, France Epidémiologie et Evaluation Cliniques, Pôle S2R, F-54000, Centre Hospitalier Universitaire, Nancy, France.
authors.forename: Marie-Line
authors.initials: ML
authors.lastname: Erpelding
authors.affiliation: Inserm U738, Université Paris Diderot, Paris 7, Faculté de Médecine Bichat, Paris, France Inserm CIC 007, AP-HP, Centre Hospitalier Universitaire Bichat, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
authors.affiliation: UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté, Besançon, France Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chirouze
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D004697:Endocarditis, Bacterial / Q000150:complications / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors