Sex-specific Differences in Infective Endocarditis: A Systematic Review and Meta-analysis of Clinical Profiles and Management Outcomes

Overview

Journal Int J Cardiol Heart Vasc

Date 2025 Feb 3

PMID 39897414

Authors

Heba T Salim

Yousef A Hamad

Huda Alwadiya

Woroud Siriya

Baraa Mansour

Haya Alhadad

Walid Marouf

Mohammed Ayyad

Ragavendar Saravanabavanandan

Saif Almaghrabi

Mohammed Al-Tawil

Assad Haneya

Affiliations

Soon will be listed here.

Abstract

Background: Infective endocarditis (IE) presents significant morbidity and mortality, with potential sex differences in clinical profile and outcomes. This is the first meta-analysis that aims to compare the clinical profile and outcomes of IE between males and females.

Methods: We conducted a meta-analysis of nine studies evaluating the clinical profile and outcomes of IE in males versus females extracted from PubMed, EMBASE, SCOPUS, and Cochrane databases up to 1st of Jan 2024.

Results: Our meta-analysis revealed notable sex differences in the incidence and complications of IE. Males exhibited a higher incidence of aortic valve IE (RR 1.57, 95 % CI [1.31, 1.88]), surgical indications for IE (RR 1.38, [1.12, 1.70]), Streptococci infection (RR 1.36, [1.04, 1.77]), intracardiac abscess (RR 1.22, [1.05, 1.42]), and Enterococci IE (RR 1.44, [1.28, 1.61]). In contrast, females had a higher incidence of mitral valve IE (RR 0.79, [0.67, 0.94]) and a higher in-hospital mortality rate (RR 0.84, [0.74, 0.96]). No significant sex differences were found in the incidence of valve vegetations, tricuspid valve IE, embolization, and Staphylococcus IE. In-hospital stay was longer in male patients, however, with borderline significance (RR 3.15, [-0.16, 6.45], p = 0.06). In patients who underwent surgery for IE, mortality rates were significantly lower in male patients (RR: 0.67 [0.59, 0.76], p < 0.01).

Conclusions: Compared to females, males exhibit higher rates of aortic valve IE, intracardiac abscess, streptococci IE, enterococci IE and IE-related surgery indication. In contrast, females have higher rates of mitral valve IE and in-hospital mortality.

References

Saravanabavanandan R, Jaimalani A, Naseer Khan M, Riaz S, Mangas G, Ahsan S . Gender-Based Outcome Discrepancies in Patients Who Underwent Alcohol Septal Ablation or Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-Analysis. Am J Cardiol. 2023; 208:134-142. DOI: 10.1016/j.amjcard.2023.09.033. View

Taneja V . Sex Hormones Determine Immune Response. Front Immunol. 2018; 9:1931. PMC: 6119719. DOI: 10.3389/fimmu.2018.01931. View

Bhandari R, Tiwari S, Alexander T, Annie F, Kaleem U, Irfan A . Sex Differences in Characteristics of Patients with Infective Endocarditis: A Multicenter Study. J Clin Med. 2022; 11(12). PMC: 9224802. DOI: 10.3390/jcm11123514. View

Woodward M . Cardiovascular Disease and the Female Disadvantage. Int J Environ Res Public Health. 2019; 16(7). PMC: 6479531. DOI: 10.3390/ijerph16071165. View

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021; 10(1):89. PMC: 8008539. DOI: 10.1186/s13643-021-01626-4. View

Friedrich C, Salem M, Puehler T, Panholzer B, Herbers L, Reimers J . Sex-Specific Risk Factors for Short- and Long-Term Outcomes after Surgery in Patients with Infective Endocarditis. J Clin Med. 2022; 11(7). PMC: 8999412. DOI: 10.3390/jcm11071875. View

Murdoch D, Corey G, Hoen B, Miro J, Fowler Jr V, Bayer A . Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009; 169(5):463-73. PMC: 3625651. DOI: 10.1001/archinternmed.2008.603. View

Weber C, Gassa A, Rokohl A, Sabashnikov A, Deppe A, Eghbalzadeh K . Severity of Presentation, Not Sex, Increases Risk of Surgery for Infective Endocarditis. Ann Thorac Surg. 2018; 107(4):1111-1117. DOI: 10.1016/j.athoracsur.2018.10.033. View

Barca L, Vidal-Bonnet L, Farinas M, Munoz P, Minero M, de Alarcon A . Analysis of sex differences in the clinical presentation, management and prognosis of infective endocarditis in Spain. Heart. 2021; 107(21):1717-1724. DOI: 10.1136/heartjnl-2021-319254. View

10.

Selton-Suty C, Celard M, Moing V, Doco-Lecompte T, Chirouze C, Iung B . Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey. Clin Infect Dis. 2012; 54(9):1230-9. DOI: 10.1093/cid/cis199. View

11.

Sambola A, Fernandez-Hidalgo N, Almirante B, Roca I, Gonzalez-Alujas T, Serra B . Sex differences in native-valve infective endocarditis in a single tertiary-care hospital. Am J Cardiol. 2010; 106(1):92-8. DOI: 10.1016/j.amjcard.2010.02.019. View

12.

Doenst T, Faerber G . Challenge-skill balance in cardiac surgery: an attempt to explain sex-related differences in coronary surgery. Eur Heart J. 2024; 45(28):2545-2547. DOI: 10.1093/eurheartj/ehae350. View

13.

Dohmen P, Binner C, Mende M, Daviewala P, Etz C, Borger M . Gender-Based Long-Term Surgical Outcome in Patients with Active Infective Aortic Valve Endocarditis. Med Sci Monit. 2016; 22:2520-7. PMC: 4962753. DOI: 10.12659/msm.899360. View

14.

Summerhill V, Moschetta D, Orekhov A, Poggio P, Myasoedova V . Sex-Specific Features of Calcific Aortic Valve Disease. Int J Mol Sci. 2020; 21(16). PMC: 7460640. DOI: 10.3390/ijms21165620. View

15.

Thuny F, Grisoli D, Cautela J, Riberi A, Raoult D, Habib G . Infective endocarditis: prevention, diagnosis, and management. Can J Cardiol. 2014; 30(9):1046-57. DOI: 10.1016/j.cjca.2014.03.042. View

16.

Aksoy O, Meyer L, Cabell C, Kourany W, Pappas P, Sexton D . Gender differences in infective endocarditis: pre- and co-morbid conditions lead to different management and outcomes in female patients. Scand J Infect Dis. 2007; 39(2):101-7. DOI: 10.1080/00365540600993285. View

17.

. Correction to: 2023 ESC Guidelines for the management of endocarditis: Developed by the task force on the management of endocarditis of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS).... Eur Heart J. 2023; 44(45):4780. DOI: 10.1093/eurheartj/ehad625. View

18.

Wan X, Wang W, Liu J, Tong T . Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014; 14:135. PMC: 4383202. DOI: 10.1186/1471-2288-14-135. View

19.

Yoon K, Kim N . Roles of Sex Hormones and Gender in the Gut Microbiota. J Neurogastroenterol Motil. 2021; 27(3):314-325. PMC: 8266488. DOI: 10.5056/jnm20208. View

20.

Kildahl H, Brenne E, Dalen H, Wahba A . Systemic embolization in infective endocarditis. Indian J Thorac Cardiovasc Surg. 2024; 40(Suppl 1):40-46. PMC: 11139814. DOI: 10.1007/s12055-023-01616-2. View