Left-sided infective endocarditis in patients with liver cirrhosis

J Infect. 2015 Dec;71(6):627-41. doi: 10.1016/j.jinf.2015.09.005. Epub 2015 Sep 25.


Objective: To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery.

Methods: Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals.

Results: A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p < 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23-1.85; p < 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery.

Conclusions: Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.

Keywords: Left-sided infectious endocarditis; Liver cirrhosis; Prognostic; Risk stratification; Surgery.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiac Surgical Procedures
  • Cohort Studies
  • Endocarditis, Bacterial / complications*
  • Endocarditis, Bacterial / epidemiology*
  • Endocarditis, Bacterial / mortality
  • Female
  • Humans
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / microbiology
  • Liver Cirrhosis / mortality
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Spain / epidemiology