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Severity of anaemia and association with all-cause mortality in patients with medically managed left-sided endocarditis.

Authors
  • Pries-Heje, Mia Marie1
  • Hasselbalch, Rasmus Bo2
  • Wiingaard, Christoffer3
  • Fosbøl, Emil Loldrup3
  • Glenthøj, Andreas Birkedal4, 5
  • Ihlemann, Nikolaj3, 6
  • Gill, Sabine Ute Alice6
  • Christiansen, Ulrik7
  • Elming, Hanne8
  • Bruun, Niels Eske5, 8, 9
  • Povlsen, Jonas Agerlund10
  • Helweg-Larsen, Jannik11
  • Schultz, Martin12
  • Østergaard, Lauge3
  • Fursted, Kurt13
  • Christensen, Jens Jørgen5, 14
  • Rosenvinge, Flemming15
  • Køber, Lars3, 5
  • Tønder, Niels16
  • Moser, Claus17
  • And 2 more
  • 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark [email protected] , (Denmark)
  • 2 Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark. , (Denmark)
  • 3 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. , (Denmark)
  • 4 Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. , (Denmark)
  • 5 Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. , (Denmark)
  • 6 Cardiology, Odense Universitetshospital, Odense, Denmark. , (Denmark)
  • 7 Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. , (Denmark)
  • 8 Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark. , (Denmark)
  • 9 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. , (Denmark)
  • 10 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. , (Denmark)
  • 11 Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. , (Denmark)
  • 12 Department of Internal Medicine, Herlev-Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark. , (Denmark)
  • 13 Bacteriology Reference Department, Statens Serum Institut, Copenhagen, Denmark. , (Denmark)
  • 14 Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark. , (Denmark)
  • 15 Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark. , (Denmark)
  • 16 Department of Cardiology, Hillerød Hospital, Hillerod, Denmark. , (Denmark)
  • 17 Department of Microbiology, Copenhagen University Hospital, Kobenhavn, Denmark. , (Denmark)
  • 18 Department of Cardiology and Department of Emergency Medicine, Herlev Hospital, Herlev, Denmark. , (Denmark)
Type
Published Article
Journal
Heart
Publisher
BMJ
Publication Date
May 12, 2022
Volume
108
Issue
11
Pages
882–888
Identifiers
DOI: 10.1136/heartjnl-2021-319637
PMID: 34611042
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To assess the prevalence and severity of anaemia in patients with left-sided infective endocarditis (IE) and association with mortality. In the Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis trial, 400 patients with IE were randomised to conventional or partial oral antibiotic treatment after stabilisation of infection, showing non-inferiority. Haemoglobin (Hgb) levels were measured at randomisation. Primary outcomes were all-cause mortality after 6 months and 3 years. Patients who underwent valve surgery were excluded due to competing reasons for anaemia. Out of 400 patients with IE, 248 (mean age 70.6 years (SD 11.1), 62 women (25.0%)) were medically managed; 37 (14.9%) patients had no anaemia, 139 (56.1%) had mild anaemia (Hgb <8.1 mmol/L in men and Hgb <7.5 mmol/L in women and Hgb ≥6.2 mmol/L) and 72 (29.0%) had moderate to severe anaemia (Hgb <6.2 mmol/L). Mortality rates in patients with no anaemia, mild anaemia and moderate to severe anaemia were 2.7%, 3.6% and 15.3% at 6-month follow-up and 13.5%, 20.1% and 34.7% at 3-year follow-up, respectively. Moderate to severe anaemia was associated with higher mortality after 6 months (HR 4.81, 95% CI 1.78 to 13.0, p=0.002) and after 3 years (HR 2.14, 95% CI 1.27 to 3.60, p=0.004) and remained significant after multivariable adjustment. Moderate to severe anaemia was present in 29% of patients with medically treated IE after stabilisation of infection and was independently associated with higher mortality within the following 3 years. Further investigations are warranted to determine whether intensified treatment of anaemia in patients with IE might improve outcome. © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

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