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Severity of anaemia and association with all-cause mortality in patients with medically managed left-sided endocarditis
  1. Mia Marie Pries-Heje1,
  2. Rasmus Bo Hasselbalch2,
  3. Christoffer Wiingaard1,
  4. Emil Loldrup Fosbøl1,
  5. Andreas Birkedal Glenthøj3,4,
  6. Nikolaj Ihlemann1,5,
  7. Sabine Ute Alice Gill5,
  8. Ulrik Christiansen6,
  9. Hanne Elming7,
  10. Niels Eske Bruun4,7,8,
  11. Jonas Agerlund Povlsen9,
  12. Jannik Helweg-Larsen10,
  13. Martin Schultz11,
  14. Lauge Østergaard1,
  15. Kurt Fursted12,
  16. Jens Jørgen Christensen4,13,
  17. Flemming Rosenvinge14,
  18. Lars Køber1,4,
  19. Niels Tønder15,
  20. Claus Moser16,
  21. Kasper Iversen4,17,
  22. Henning Bundgaard1,4
  1. 1Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  2. 2Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
  3. 3Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  4. 4Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  5. 5Cardiology, Odense Universitetshospital, Odense, Denmark
  6. 6Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
  7. 7Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
  8. 8Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  9. 9Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
  10. 10Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  11. 11Department of Internal Medicine, Herlev-Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
  12. 12Bacteriology Reference Department, Statens Serum Institut, Copenhagen, Denmark
  13. 13Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
  14. 14Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
  15. 15Department of Cardiology, Hillerød Hospital, Hillerod, Denmark
  16. 16Department of Microbiology, Copenhagen University Hospital, Kobenhavn, Denmark
  17. 17Department of Cardiology and Department of Emergency Medicine, Herlev Hospital, Herlev, Denmark
  1. Correspondence to Dr Mia Marie Pries-Heje, Department of Cardiology, Rigshospitalet, Copenhagen 2100, Denmark; mia.marie.pries-heje.01{at}


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.

  • endocarditis
  • biomarkers

Data availability statement

No data are available.

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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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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