title: Left-sided infective endocarditis in patients with liver cirrhosis.
abstract: OBJECTIVE
  To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery.
  
  
  METHODS
  Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals.
  
  
  RESULTS
  A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p < 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23-1.85; p < 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery.
  
  
  CONCLUSIONS
  Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.
authors.affiliation: UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain. Electronic address: mjruizm@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Ruiz-Morales
authors.affiliation: Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain. Electronic address: drradabg@yahoo.com.
authors.forename: R
authors.initials: R
authors.lastname: Ivanova-Georgieva
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain. Electronic address: nufernan@gmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Fernández-Hidalgo
authors.affiliation: UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain. Electronic address: emiliogcabrera@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: García-Cabrera
authors.affiliation: Hospital Clinic - IDIBAPS, Servicio de Enfermedades Infecciosas y Microbiología, Universidad de Barcelona, Barcelona, Spain. Electronic address: jmmiro@ub.edu.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miró
authors.affiliation: Servicio de Microbiología y Enfermedades infecciosas, H. Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain. Electronic address: pmunoz@micro.hggm.es.
authors.forename: P
authors.initials: P
authors.lastname: Muñoz
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain. Electronic address: benitoalmirante@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Almirante
authors.affiliation: UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital General Universitario, Málaga, Spain. Electronic address: nonispc@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Plata-Ciézar
authors.affiliation: Unidad de Hospitalización a Domicilio, H. Universitario Gregorio Marañón, Madrid, Spain. Electronic address: vgramallo@orange.es.
authors.forename: V
authors.initials: V
authors.lastname: González-Ramallo
authors.affiliation: UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain. Electronic address: jga@us.es.
authors.forename: J
authors.initials: J
authors.lastname: Gálvez-Acebal
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain. Electronic address: mcfarinas@humv.es.
authors.forename: M C
authors.initials: MC
authors.lastname: Fariñas
authors.affiliation: Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario Juan Canalejo, A Coruña, Spain. Electronic address: josem.bravoferrer.acosta@hotmail.com.
authors.forename: J M
authors.initials: JM
authors.lastname: Bravo-Ferrer
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián, Spain. Electronic address: goenagasanchez@gmail.com.
authors.forename: M A
authors.initials: MA
authors.lastname: Goenaga-Sánchez
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain. Electronic address: chidalgo72@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Hidalgo-Tenorio
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitario Cruces, Bilbao, Spain. Electronic address: anejosune.goikoetxeaagirre@osakidetza.net.
authors.forename: J
authors.initials: J
authors.lastname: Goikoetxea-Agirre
authors.affiliation: UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain. Electronic address: aa2406ge@yahoo.es.
authors.forename: A
authors.initials: A
authors.lastname: de Alarcón-González
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
keywords: Left-sided infectious endocarditis; Liver cirrhosis; Prognostic; Risk stratification; Surgery