Sex-specific aspects for the management of suspected infectious endocarditis

Introduction: Infectious endocarditis (IE) is a bacterial infection of the endocardial surface of the heart with high mortality rates. Rapid diagnosis is crucial for reducing these rates, but the broad range of risk factors and the often multisystemic clinical manifestations of IE pose significant diagnostic challenges. While there is evidence suggesting that IE may manifest or progress differently between sexes, gender is not considered in the current guidelines for the management of IE.

Aim: The objective of this study was to assess sex-specific differences in suspected IE.

Methods: We conducted a retrospective observational study at Ulm University Hospital, Ulm, Germany, including consecutive patients admitted with suspected IE between 2009 and 2019. IE was diagnosed according to guideline-specific recommendations using the 2015 ESC Duke criteria. The patients were divided into two groups according to their sex (male and female). We compared the groups and assessed risk factors, clinical presentation and in-hospital outcomes.

Results: A total of 163 patients with suspected IE were admitted during the study period, comprising 118 males and 45 females. Of these, 129 (79.1 %) were diagnosed with IE, with no significant difference between the groups (p = 0.121). Regarding all 163 patients, the mean age of women was 74 years, compared to 66 years among men (p = 0.006). The male patients were more likely to have predisposing cardiac risk factors or intravenous drug abuse (p = 0.012), poor dental status (p = 0.037), a history of implantable cardioverter defibrillator (ICD) implantation (p = 0.043) and known coronary artery disease (p = 0.003). Furthermore, they exhibited a higher prevalence of splenomegaly (p = 0.005), while women were more likely to present with thyroid dysfunction (p = 0.006). The incidence of the complications of heart failure (p = 0.01) and acute kidney injury requiring new-onset dialysis during the hospital stay (p = 0.037) were more common in male patients. Suitable with this, the length of the intensive care unit stay was longer among male patients (p = 0.012). Mortality did not significantly differ between the sexes (p = 0.371).

Conclusion: Men with suspected IE are more likely to have predisposing factors for IE and cardiac comorbidities while the frequency of positive Duke criteria is comparable to women. The course of disease is more severe in men, as evidenced by a higher rate of organ failure, the need for intensive care treatment and similar mortality as women despite younger age. Consequently, an assessment of patients' histories could help to improve management of suspected IE in men to meet their increased morbidity.