title: Infective endocarditis in patients with hepatic diseases.
abstract: Few data have been published regarding the epidemiology and outcome of infective endocarditis (IE) in patients with chronic hepatic disease (CHD). A retrospective analysis of the Studio Endocarditi Italiano (SEI) database was performed to evaluate the epidemiology and outcome of CHD+ patients compared with CHD- patients. The diagnosis of IE was defined in accordance with the modified Duke criteria. Echocardiography, diagnosis, and treatment procedures were in accordance with current clinical practice. Among the 1722 observed episodes of IE, 300 (17.4 %) occurred in CHD+ patients. The cause of CHD mainly consisted of chronic viral infection. Staphylococcus aureus was the most common bacterial species in CHD+ patients; the frequency of other bacterial species (S. epidermidis, streptococci, and enterococci) were comparable among the two groups. The percentage of patients undergoing surgery for IE was 38.9 in CHD+ patients versus 43.7 in CHD- patients (p = 0.06). Complications were more common among CHD+ patients (77 % versus 65.3 %, p < 0.001); embolization (43.3 % versus 26.1 %, p < 0.001) and congestive heart failure (42 % versus 34.1 %, p = 0.01) were more frequent among CHD+ patients. Mortality was comparable (12.5 % in CHD- and 15 % in CHD+ patients). At multivariable analysis, factors associated with hospital-associated mortality were having an infection sustained by S. aureus, a prosthetic valve, diabetes and a neoplasia, and CHD. Being an intravenous drug user (IVDU) was a protective factor and was associated with a reduced death risk. CHD is a factor worsening the prognosis in patients with IE, in particular in patients for whom cardiac surgery was required.
authors.affiliation: Clinica di Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. e.seminari@smatteo.pv.it.
authors.forename: E
authors.initials: E
authors.lastname: Seminari
authors.affiliation: Direzione Scientifica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: De Silvestri
authors.affiliation: USC Malattie Infettive, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Ravasio
authors.affiliation: Clinica di Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Ludovisi
authors.affiliation: Internal Medicine Section, University of Naples S.U.N., Napoli, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Utili
authors.affiliation: 2nd Division of Infectious Diseases, National Institute for Infectious Diseases "Spallanzani", Roma, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Petrosillo
authors.affiliation: Clinica di Malattie Infettive e Tropicali, Università degli Studi di Brescia, Brescia, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Castelli
authors.affiliation: Clinica di Malattie Infettive, AOU Santa Maria della Misericordia, Udine, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bassetti
authors.affiliation: UO Malattie Infettive e Tropicali, Azienda Ospedaliera di Padova, Padova, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Barbaro
authors.affiliation: Clinica di Malattie Infettive e Tropicali, Università degli Studi dell'Insubria, Varese, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Grossi
authors.affiliation: UO Terapia Intensiva, Cardiochirurgica, ASO S. Croce e Carle, Cuneo, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Barzaghi
authors.affiliation: USC Malattie Infettive, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Rizzi
authors.affiliation: Clinica di Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Minoli
mesh_terms: D000328:Adult; D000368:Aged; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008107:Liver Diseases / Q000453:epidemiology* / Q000382:microbiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013212:Staphylococcus epidermidis / Q000302:isolation & purification