Predictors of Surgical Intervention in Dialysis Patients With Infective Endocarditis

Background The use of valve surgery for infective endocarditis (IE) in end-stage renal disease (ESRD) patients may be different than in the general population. We assessed predictors of early surgery in ESRD patients with IE. Methods We conducted a retrospective cohort study among dialysis patients with left-sided IE between 2005 and 2015. Indications for surgery were based on current endocarditis guidelines. Patients were categorized as early valve replacement surgery or delayed/no surgery. We used logistic regression to determine independent predictors of early surgery. Results Among 229 patients, 67 (29.3%) underwent early surgery. New congestive heart failure was the only high level of evidence indication independently associated with early surgery (odds ratio [OR], 12.1; 95% confidence interval [CI], 3.4–43.6). Transfer from outside hospital (OR, 5.4; 95% CI, 2.2–13.3), valve rupture (OR, 6.9; 95% CI, 2.6–17.9), coagulase-negative staphylococcus etiology (OR, 3.8; 95% CI, 1.4–10.6), and presence of any low level of evidence indication (OR, 5.9; 95% CI, 2.2–15.5) predicted early surgery. Preexisting valve disease (OR, 0.31; 95% CI, 0.12–0.82) and surgical contraindications (OR, 0.05; 95% CI, 0.005–0.4) predicted nonsurgical treatment. Conclusions Among ESRD patients with IE, most surgical indications are not predictive of early surgery.