Evaluate features and prognosis of bacterial endocarditis (BE), a condition whose presentation and prognosis are poorly evaluated in patients (pts) with cirrhosis (Ci). Medical charts for all pts with both BE and Ci in 14 liver units (2000-2013) were reviewed. Short term mortality was analysed by univariate and logistic regression analysis. There were 78 BE (in 77 pts), median age 64 years, 60 men (77%). Causes for Ci were: alcohol: 59 pts (76.6%), viral: 11 (14%), others 7 pts. The
Child-Pugh Score was A/B: 52%, C: 48%. Bilirubin 71 ± 84 µmol/l, prothrombin time (PT) 53% ± 17, albumin 25 ± 5 g/l, serum creatinine 129 ± 113 µmol/l.
Mitral (M) and aortic (A) valves were involved in 41 (insufficiency 32) and 50 (insufficiency 30) pts: 19pts had M and A valves involved. Source of contamination was digestive in 13 pts. A germ was isolated in 68 pts: Staphylococcus: 28 pts (41%), Streptococcus: 27 pts (40%), others 13 pts (Enterococcus/E.coli: 9 pts). Antibiotics: gentamicin 43 pts, amoxicillin 41 pts, vancomycin 21 pts. 40 pts died from: liver failure: 11, multi organe failure: 16, cardiogenic shock: 4, brain abscesses: 4. By univariate analysis, mortality was related with a PT < 40 % (p = 0.03). Logistic regression analysis identified PT as an independent predictor of mortality with a PT < 40%; OR = 8.3 - 95% CI [6.6 to 10].
Bacterial endocarditis has a severe prognosis in patients with cirrhosis, especially when PT is < 40%.
