American heart journal · 2026
Sex-based differences in mortality and prognostic factors for infective endocarditis: insights from a retrospective cohort of 519 patients.
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Vincent Marie, Samant Claire, Gravier-Dumonceau Robinson, Rost Selene, Gouriet Frédérique, Tessonnier Laetitia, Riberi Alberto, Runet-Arnoux Titouan, Hubert Sandrine, Lucas Claire, Collart Frédéric, Camoin-Jau Laurence, Habib Gilbert, Philip Mary
Аннотация
INTRODUCTION: Infective endocarditis (IE) remains a severe disease with high mortality despite advances in management. Although it predominantly affects male patients, female patients account for about one-quarter of cases. Sex-specific differences in outcomes and prognostic factors remain insufficiently explored.
METHODS: We conducted a retrospective study including 519 patients ≥16 years hospitalized for definite or possible IE (ESC 2023 criteria) at La Timone Hospital, Marseille, between March 2019 and October 2023. The primary endpoint was one-year mortality; secondary endpoints included surgical management, valve involvement, and prognostic factors.
RESULTS: Of the 519 patients, 26% were female patients. One-year mortality was comparable between sexes (27% in female patients vs. 23% in male patients, p = 0.415). Post-discharge mortality was not significantly different between sexes (p = 0.096). Mitral valve involvement was more frequent in female patients, and aortic involvement predominated in male patients. Independent predictors of mortality included annular complications and lack of surgery. Importantly, sex-specific differences in prognostic factors were observed in this exploratory analysis: in female patients, TAVI and ischemic heart disease were associated with higher mortality; in male patients, right-sided IE and pacemaker presence were predictive. Furthermore, fatal cases in male patients were marked by more in-hospital complications (heart failure, cardiogenic or septic shock, acute renal failure), suggesting distinct mortality pathways.
CONCLUSION: Although overall mortality was similar between sexes, male patients and female patients with IE appeared to show different prognostic profiles in this single-center cohort. These preliminary, hypothesis-generating findings suggest that some established risk factors may largely reflect male data, emphasizing the need for larger, multicenter studies to confirm sex-specific determinants and improve individualized management.
METHODS: We conducted a retrospective study including 519 patients ≥16 years hospitalized for definite or possible IE (ESC 2023 criteria) at La Timone Hospital, Marseille, between March 2019 and October 2023. The primary endpoint was one-year mortality; secondary endpoints included surgical management, valve involvement, and prognostic factors.
RESULTS: Of the 519 patients, 26% were female patients. One-year mortality was comparable between sexes (27% in female patients vs. 23% in male patients, p = 0.415). Post-discharge mortality was not significantly different between sexes (p = 0.096). Mitral valve involvement was more frequent in female patients, and aortic involvement predominated in male patients. Independent predictors of mortality included annular complications and lack of surgery. Importantly, sex-specific differences in prognostic factors were observed in this exploratory analysis: in female patients, TAVI and ischemic heart disease were associated with higher mortality; in male patients, right-sided IE and pacemaker presence were predictive. Furthermore, fatal cases in male patients were marked by more in-hospital complications (heart failure, cardiogenic or septic shock, acute renal failure), suggesting distinct mortality pathways.
CONCLUSION: Although overall mortality was similar between sexes, male patients and female patients with IE appeared to show different prognostic profiles in this single-center cohort. These preliminary, hypothesis-generating findings suggest that some established risk factors may largely reflect male data, emphasizing the need for larger, multicenter studies to confirm sex-specific determinants and improve individualized management.