Trends in the Clinical Characteristics and Outcome of Infective Endocarditis: A Nationwide Study From 2016 to 2021
Hiroshi Okamoto, Takeshi Nishi, Kyo Kamisaka, Yoshitaka Sasahira, Koshiro Kanaoka, Yoko Sumita, Yoshitaka Iwanaga, Chisato Izumi, Shiro Uemura
Abstract
BACKGROUND: Infective endocarditis (IE) is still a fatal disease, and given its rarity, ongoing updates to patient characteristics and outcomes of IE are essential for providing precision diagnoses and effective treatments. This study sought to examine temporal trends in the clinical characteristics and in-hospital occurrence of adverse outcomes of IE. METHODS AND RESULTS: Using the Japan nationwide administrative database, we identified patients with IE in Japan from 2016 to 2021. A total of 17 407 patients with IE (37.8% women; median age, 72 [interquartile range, 59-81] years) were identified. The incidence of IE increased from 2.02 per 100 000 population in 2016 to 2.59 per 100 000 population in 2021. The median age of the patients increased from 70 years in 2016 to 73 years in 2021, and patient backgrounds were becoming more complex. The in-hospital mortality rate was 14.5%, which significantly increased from 14.1% in 2016 to 15.4% in 2021. Higher age (odds ratio [OR], 1.34 [95% CI, 1.29-1.40]), heart failure (OR, 1.37 [95% CI, 1.18-1.59]), cerebrovascular complications (OR, 1.78 [95% CI, 1.59-1.99]), renal failure (OR, 2.36 [95% CI, 2.06-2.70]), and sepsis (OR, 2.79 [95% CI, 2.48-3.13]), were independently associated with an increased in-hospital mortality rate. In contrast, cardiac surgery (OR, 0.47 [95% CI, 0.41-0.55]), and a higher number of total cardiac surgeries (OR, 0.77 [95% CI, 0.65-0.92]) independently predicted a lower in-hospital mortality rate. CONCLUSIONS: The characterization and comprehensive analysis of IE in Japan provides valuable insights into the epidemiology, risk factors, and outcomes of IE, which may inform health service planning and treatment strategies.