Analysis of sex differences in the clinical presentation, management and prognosis of infective endocarditis in Spain
Laura Varela Barca, Laura Vidal-Bonnet, M. Carmen Fariñas, Patricia Muñóz, Maricela Valerio Minero, Arístides de Alarcón, Encarnación Gutiérrez Carretero, Manuel Cuadra, Asunción Moreno Camacho, Xabier Kortajarena Urkola, Josune Goikoetxea, Guillermo Ojeda, Luis Eduardo López-Cortés, JC Porres Azpiroz, José López Menéndez
Abstract
INTRODUCTION: Sex-dependent differences of infective endocarditis (IE) have been reported. Women suffer from IE less frequently than men and tend to present more severe manifestations. Our objective was to analyse the sex-based differences of IE in the clinical presentation, treatment, and prognosis. MATERIAL AND METHODS: We analysed the sex differences in the clinical presentation, modality of treatment and prognosis of IE in a national-level multicentric cohort between 2008 and 2018. All data were prospectively recorded by the GAMES cohort (Spanish Collaboration on Endocarditis). RESULTS: aetiology was more frequent in women (30.1% vs 23.1%; p<0.001).Surgery was performed in 38.3% of women and 50% of men. After propensity score (PS) matching for age and estimated surgical risk (European System for Cardiac Operative Risk Evaluation II (EuroSCORE II)), the analysis of the matched cohorts revealed that women were less likely to undergo surgery (OR 0.74; 95% CI 0.59 to 0.91; p=0.05).The observed overall in-hospital mortality was 32.8% in women and 25.7% in men (OR for the mortality of female sex 1.41; 95% CI 1.21 to 1.65; p<0.001). This statistical difference was not modified after adjusting for all possible confounders. CONCLUSIONS: Female sex was an independent factor related to mortality after adjusting for confounders. In addition, women were less frequently referred for surgical treatment.