Impact of Surgical Valve Intervention on In-Hospital Outcomes in Candida Endocarditis: A Seven-Year Analysis

Authors

Bekure B. Siraw, Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago, IL, USA. Electronic address: bekure.siraw.eras@gmail.com.
Didien Meyahnwi, Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA.
Yordanos T. Tafesse, Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago, IL, USA.
Neiberg Lima, Heart and Vascular Institute, Hartford Healthcare, Hartford, CT, USA.
Juveriya Yasmeen, Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago, IL, USA.
Hemraj Paudel, Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago, IL, USA.
Amha Weldehana, Department of Internal Medicine, Westchester Medical Center, Valhalla, NY, USA.
Titilope Olanipekun, Department of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Mouaz Oudih, Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago, IL, USA.
Yonas Gebrecherkos, Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago, IL, USA.
Mohammed Haroun, Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago, IL, USA.

Document Type

Article

Publication Title

The American journal of cardiology

Abstract

Candida endocarditis (CE) is a rare but highly lethal infection with limited evidence guiding its management. While surgical valve replacement or repair is often recommended, its impact on in-hospital outcomes remains unclear. We conducted a retrospective cohort study using the National Inpatient Sample (2016-2022) to identify adult admissions with CE. The primary exposure was surgical valve intervention. The primary outcomes were overall and 30-day in-hospital mortality, while the secondary outcomes included length of stay and hospitalization costs. We used multivariable logistic regression, Cox proportional hazards models, and two causal inference methods, propensity score matching (PSM) and inverse probability of treatment weighting (IPTW), to adjust for potential confounding. We identified 1,280 weighted CE hospitalizations, representing 0.77% of infective endocarditis cases. Among them, 228 patients (17.8%) underwent valve intervention, with a median time to surgery of 9.5 days (IQR = 15 days). Overall, in-hospital mortality was 18.8%, significantly lower in those who underwent surgery (8.3% vs. 21.1%; p < 0.001). Valve intervention was associated with reduced mortality across multivariable analysis (AOR 0.28; 95% CI: 0.13-0.55), PSM (OR 0.31; 95% CI: 0.13-0.66), IPTW (OR 0.42; 95% CI: 0.25-0.71), and Cox models (AHR 0.13; 95% CI: 0.07-0.25). However, intervention was also linked to longer hospital stays (β = 1.86; 95% CI: 1.61-2.14) and higher costs (β = 2.10; 95% CI: 1.71-2.61). Surgical valve intervention in patients with CE was associated with significantly lower in-hospital mortality, but at the cost of longer hospital stays and increased resource utilization.

DOI

10.1016/j.amjcard.2025.06.019

Publication Date

7-4-2025

Recommended Citation

Siraw, Bekure B.; Meyahnwi, Didien; Tafesse, Yordanos T.; Lima, Neiberg; Yasmeen, Juveriya; Paudel, Hemraj; Weldehana, Amha; Olanipekun, Titilope; Oudih, Mouaz; Gebrecherkos, Yonas; and Haroun, Mohammed, "Impact of Surgical Valve Intervention on In-Hospital Outcomes in Candida Endocarditis: A Seven-Year Analysis" (2025). Systematic Reviews. 45.
https://scholar.bridgeporthospital.org/descriptive_study/45

Identifier

40618864 (pubmed); 10.1016/j.amjcard.2025.06.019 (doi); S0002-9149(25)00378-9 (pii)