Infectious Endocarditis in Patients with Cirrhosis: Epidemiology, Characteristics and Outcome - Abstract
Bacterial infections are frequent in patients with cirrhosis with a 4-fold increase
mortality. Spontaneous bacterial peritonitis, urinary tract infections and pneumonia are
the most common infections observed but few data concerning infectious endocarditis
(IE) are available. Some old studies suggested a higher prevalence of IE in patients
with cirrhosis compared to general population. Regarding clinical features, patients
were usually men, older than 55 years old with an alcoholic cirrhosis and a cardiopathy
history. IE were mostly located on aortic and mitral valve. Gram positive bacteria
were involved in 74-100% of cases with about 26-80% of Staphylococcus aureus,
due to nosocomial infections. Enterococci and Gram negative bacteria were observed
respectively in 6-19% and 3-5% of cases. Compared to general population, fewer
patients underwent cardiac valve surgery, a fact grossly related toliver insufficiency.
Selection criteria for surgery have to be refined since postoperative mortality could be
less than 10% in selected cirrhotic patients with liver insufficiency. Mortality rates were
high and associated with the severity of the liver disease. A prothrombin time ?40%
appeared as an independent risk factor of mortality.