https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Ulm Klinik für Innere Medizin II Ulm, Deutschland; 2Alb-Donau Klinikum Innere Medizin Ehingen (Donau), Deutschland; 3Universitätsklinikum Ulm Institut für Epidemiologie und Medizinische Biometrie Ulm, Deutschland
Introduction: Men with suspected infectious endocarditis (IE) show a more severe early course of disease, as evidenced by higher age-adjusted in-hospital mortality rates compared to women. In particular, in high-risk patients, rapid diagnosis is crucial as early targeted therapy improves patient outcomes. However, while men’s more pronounced risk factors facilitate early diagnosis, the gender-specific implications of diagnostic delay in IE remain unclear.
Aim: This study assessed gender-specific time to diagnosis after hospital admission and its subsequent impact on outcomes in patients with suspected IE.
Methods: We conducted a retrospective observational study at the Department of Internal Medicine II 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 2023 Duke criteria. The patients were divided into two groups according to their sex (male and female). The time to diagnosis was assessed and compared between the groups, along with its effect on in-hospital outcomes.
Results: In total, IE was diagnosed in 96 of 118 males (81.4%) and 33 of 45 females (73.3%) (p = 0.121). Time to diagnosis was similar between the groups (males 5.4 ± 8.0 vs. females 4.7 ± 4.0 days, p = 0.598). Regarding patients` demographics, males were younger than females (65.5 vs. 74.3 years, p = 0.006). Notably, in the male cohort, a shorter time to diagnosis was associated with lower in-hospital mortality (p = 0.035, optimal cut-point 3.5 days). Males diagnosed within 3.5 days had an event rate of 13.5%, compared to 31.8% for those diagnosed later (p = 0.028). Accordingly, there was a strong trend towards a longer time to diagnosis in patients who died (8.8 ± 11.1 vs. 4.5 ± 6.8 days, p = 0.071). In contrast, no association between time to diagnosis and in-hospital mortality was observed among women (p = 0.988, in-hospital mortality 13.3%). Accordingly, there was no difference in time to diagnosis between females who survived and those who did not (p = 0.982).
Conclusion: In men, diagnosing IE within a critical 3.5 days window after admission is associated with a reduced and in-hospital mortality. Thus, in male patients with suspected IE, diagnosis should be pursued as an emergency in order to meet their poor outcomes.