860. Predictors of Mortality in End Stage Renal Disease Patients with Infective Endocarditis
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 9, 2015
Room: Poster Hall

Background: Patients undergoing dialysis for ESRD have frequent bacteremia and are at increased risk for IE, but their outcomes are unclear. 

Methods: All ESRD patients admitted to 2 university hospitals from 1992-2012 were retrospectively screened for IE using ICD-9 codes. Chart reviews were performed and diagnosis of IE was confirmed using the modified Duke criteria. Categorical variables were compared using χ2or Fisher's exact test and continuous variables with the t-test. Mortality was assessed at 30 days, 1 year, and 3 years. Survival analysis was used to compare patients who did and did not undergo valve replacement surgery. A Cox proportional hazards model was used to calculate hazard ratios (HR) for death.

Results: Over 21 years, 258 ESRD patients had IE.  Half were female, the median age was 55 years, and the mean duration of follow-up was 416 627 days. Overall, 58% of patients had dialysis catheters, 21% had thrombocytopenia ( 150x109/L), 20% had embolic stroke, and 54% had a vegetation ³ 1.5cm.  Staphylococci were the most common pathogens (24% MSSA, 21% MRSA, 18% coagulase negative). Mortality rates were 28% at 30 days, 57% at 1 year, and 76% at 3 years. 26% of patients underwent valve replacement surgery, which was associated with improved survival at 3 years compared to those who did not undergo surgery (figure 1, p=0.03). Age ³ 65 (HR 4.6, 95% CI 2.7–7.9), embolic stroke (HR 2.9, 95% CI 1.7 – 5.0), thrombocytopenia (HR 2.0, 95% CI 1.2 – 3.4), and prosthetic valve endocarditis (HR 2.3, 95% CI 1.1 – 4.9) predicted death in the multivariate analysis, while microbiology and vegetation size were not predictive of mortality.   

Conclusion: ESRD patients with IE have high mortality, mostly due to non-modifiable risk factors. Efforts aimed at prevention and early diagnosis will likely have a greater benefit in decreasing mortality than altering current management strategies. Careful risk assessment for surgery should be performed in these patients.

Rachel Powell, MD1, James P. Steinberg, MD, FIDSA, FSHEA2 and Jesse T. Jacob, MD2, (1)Emory University School of Medicine, Atlanta, GA, (2)Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA

Disclosures:

R. Powell, None

J. P. Steinberg, None

J. T. Jacob, None

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