Sex-related differences in infective endocarditis. A retrospective study in a high-volume surgical centre

Background: Despite advancements in diagnostic and therapeutic strategies, infective endocarditis (IE) remains associated with high morbidity and mortality rates. Recent studies have highlighted significant sex-related differences in the clinical presentation, management, and outcomes of IE, reporting conflicting results. Objectives: identifying the sex-related differences of patients with IE in clinical presentation and predictors of all-cause mortality. Methods: We conducted a retrospective study at a high-volume surgical centre, examining 687 new cases of non-device-related IE admitted between January 2013 and November 2023. Data were collected from anonymized electronic hospital records, including demographic, clinical, echocardiographic, and microbiologic characteristics. Statistical analyses were performed to identify sex-related differences in clinical presentation and predictors of all-cause mortality. Results: Female patients represented 34% of the cohort and were significantly older than males (69.6 vs. 63.9 years, p < 0.001). Females had higher prevalence of diabetes (24.8% vs. 18.1%, p = 0.039) and hypertension (65.8% vs. 57%, p = 0.025). Mitral valve IE was more common in females (46.6% vs. 36%, p = 0.023), while males had higher incidence of spondylodiscitis (10.2% vs. 3.4%, p = 0.002). Overall mortality was higher in females, but sex was not an independent predictor of mortality at multivariable analysis. Conclusion: Our study highlights important sex-based differences in IE, emphasizing the need for sex-specific approaches to diagnosis, treatment, and management. Recognizing and addressing these differences can improve outcomes for both male and female patients with IE.