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.
Data availability statement
No data are available.
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KI and HB are joint last authors.
Contributors The study was designed and initiated by MMP-H, HB and KI. Data acquisition was done by MMP-H, RBH, CW, NI, SUAG, UC, HE, NEB, JAP, JH-L, KF, JJC, FSR, LK, NT, CM, KI and HB. Data analysis was done by MMP-H, RBH, KI and HB. The first draft was written by MMP-H, KI and HB. All authors critically revised the manuscript and agree to be accountable for all aspects of the work.
Funding This work was supported by grants from the Danish Heart Foundation, the Svend Andersens Foundation, the Capital Regions Research Council, the Hartmann’s Foundation and the Novo Nordisk Foundation.
Competing interests LK received speaker’s honorarium from Novo, Novartis, AstraZeneca and Boehringer, unrelated to this study. NEB received investigator-initiated grant from the Novo Nordisk Foundation and from the Region of Zealand, not related to this study. ELF has received independent research grant from Novo Nordisk Foundation, unrelated to this study. The other authors have nothing to declare.
Provenance and peer review Not commissioned; externally peer reviewed.
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