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

Mia Marie Pries-Heje; Rasmus Bo Hasselbalch; Christoffer Wiingaard; Emil Loldrup Fosbøl; Andreas Birkedal Glenthøj; Nikolaj Ihlemann; Sabine Ute Alice Gill; Ulrik Christiansen; Hanne Elming; Niels Eske Bruun; Jonas Agerlund Povlsen; Jannik Helweg-Larsen; Martin Schultz; Lauge Østergaard; Kurt Fursted; Jens Jørgen Christensen; Flemming Rosenvinge; Lars Køber; Niels Tønder; Claus Moser; Kasper Iversen; Henning Bundgaard

doi:10.1136/heartjnl-2021-319637

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

Mia Marie Pries-Heje^*, Rasmus Bo Hasselbalch, Christoffer Wiingaard, Emil Loldrup Fosbøl, Andreas Birkedal Glenthøj, Nikolaj Ihlemann, Sabine Ute Alice Gill, Ulrik Christiansen, Hanne Elming, Niels Eske Bruun, Jonas Agerlund Povlsen, Jannik Helweg-Larsen, Martin Schultz, Lauge Østergaard, Kurt Fursted, Jens Jørgen Christensen, Flemming Rosenvinge, Lars Køber, Niels Tønder, Claus MoserKasper Iversen, Henning Bundgaard

^*Kontaktforfatter

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Abstract

OBJECTIVE: To assess the prevalence and severity of anaemia in patients with left-sided infective endocarditis (IE) and association with mortality.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

Originalsprog	Engelsk
Tidsskrift	Heart
Vol/bind	108
Udgave nummer	11
Sider (fra-til)	882-888
ISSN	1355-6037
DOI	https://doi.org/10.1136/heartjnl-2021-319637
Status	Udgivet - 12. maj 2022

Bibliografisk note

Dokumenter og links

10.1136/heartjnl-2021-319637

Citationsformater

Pries-Heje, M. M., Hasselbalch, R. B., Wiingaard, C., Fosbøl, E. L., Glenthøj, A. B., Ihlemann, N., Gill, S. U. A., Christiansen, U., Elming, H., Bruun, N. E., Povlsen, J. A., Helweg-Larsen, J., Schultz, M., Østergaard, L., Fursted, K., Christensen, J. J., Rosenvinge, F., Køber, L., Tønder, N., ... Bundgaard, H. (2022). Severity of anaemia and association with all-cause mortality in patients with medically managed left-sided endocarditis. Heart, 108(11), 882-888. https://doi.org/10.1136/heartjnl-2021-319637

@article{d8ccc724746a48c39b5ba51ffd73cd72,

title = "Severity of anaemia and association with all-cause mortality in patients with medically managed left-sided endocarditis",

abstract = "OBJECTIVE: To assess the prevalence and severity of anaemia in patients with left-sided infective endocarditis (IE) and association with mortality.METHODS: 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.RESULTS: 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.CONCLUSION: 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.",

keywords = "biomarkers, endocarditis",

author = "Pries-Heje, {Mia Marie} and Hasselbalch, {Rasmus Bo} and Christoffer Wiingaard and Fosb{\o}l, {Emil Loldrup} and Glenth{\o}j, {Andreas Birkedal} and Nikolaj Ihlemann and Gill, {Sabine Ute Alice} and Ulrik Christiansen and Hanne Elming and Bruun, {Niels Eske} and Povlsen, {Jonas Agerlund} and Jannik Helweg-Larsen and Martin Schultz and Lauge {\O}stergaard and Kurt Fursted and Christensen, {Jens J{\o}rgen} and Flemming Rosenvinge and Lars K{\o}ber and Niels T{\o}nder and Claus Moser and Kasper Iversen and Henning Bundgaard",

note = "{\textcopyright} Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2022",

month = may,

day = "12",

doi = "10.1136/heartjnl-2021-319637",

language = "English",

volume = "108",

pages = "882--888",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ Publishing Group",

number = "11",

}

Pries-Heje, MM, Hasselbalch, RB, Wiingaard, C, Fosbøl, EL, Glenthøj, AB, Ihlemann, N, Gill, SUA, Christiansen, U, Elming, H, Bruun, NE, Povlsen, JA, Helweg-Larsen, J, Schultz, M, Østergaard, L, Fursted, K, Christensen, JJ, Rosenvinge, F, Køber, L, Tønder, N, Moser, C, Iversen, K & Bundgaard, H 2022, 'Severity of anaemia and association with all-cause mortality in patients with medically managed left-sided endocarditis', Heart, bind 108, nr. 11, s. 882-888. https://doi.org/10.1136/heartjnl-2021-319637

TY - JOUR

T1 - Severity of anaemia and association with all-cause mortality in patients with medically managed left-sided endocarditis

AU - Pries-Heje, Mia Marie

AU - Hasselbalch, Rasmus Bo

AU - Wiingaard, Christoffer

AU - Fosbøl, Emil Loldrup

AU - Glenthøj, Andreas Birkedal

AU - Ihlemann, Nikolaj

AU - Gill, Sabine Ute Alice

AU - Christiansen, Ulrik

AU - Elming, Hanne

AU - Bruun, Niels Eske

AU - Povlsen, Jonas Agerlund

AU - Helweg-Larsen, Jannik

AU - Schultz, Martin

AU - Østergaard, Lauge

AU - Fursted, Kurt

AU - Christensen, Jens Jørgen

AU - Rosenvinge, Flemming

AU - Køber, Lars

AU - Tønder, Niels

AU - Moser, Claus

AU - Iversen, Kasper

AU - Bundgaard, Henning

PY - 2022/5/12

Y1 - 2022/5/12

N2 - OBJECTIVE: To assess the prevalence and severity of anaemia in patients with left-sided infective endocarditis (IE) and association with mortality.METHODS: 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.RESULTS: 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.CONCLUSION: 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.

AB - OBJECTIVE: To assess the prevalence and severity of anaemia in patients with left-sided infective endocarditis (IE) and association with mortality.METHODS: 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.RESULTS: 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.CONCLUSION: 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.

KW - biomarkers

KW - endocarditis

U2 - 10.1136/heartjnl-2021-319637

DO - 10.1136/heartjnl-2021-319637

M3 - Journal article

C2 - 34611042

SN - 1355-6037

VL - 108

SP - 882

EP - 888

JO - Heart

JF - Heart

IS - 11

ER -

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

Abstract

Bibliografisk note

Dokumenter og links

Fingeraftryk

Citationsformater