Sex Differences in Clinical Outcomes and Surgical Interventions for Infective Endocarditis: A Nationwide Registry

Background Sex differences in infective endocarditis (IE) remain underexplored in large-scale studies. Current findings on clinical outcomes, particularly in surgical IE, are inconsistent, highlighting critical knowledge gaps. Methods We conducted a nationwide cohort study using the Taiwan National Health Insurance Research Database (2001-2022) and a total of 28 976 adults with IE were identified. Subgroup analysis focused on 4133 patients undergoing valve surgery. Primary outcomes included in-hospital mortality and long-term survival, analyzed using logistic regression and Cox models. Results Of 28 976 patients, 4133 underwent surgery (women/men: 10 580/18 396 overall; 1252/2881 surgical). Women were older with more comorbidities. After propensity score matching, women had higher in-hospital mortality in both the general cohort (21.2% vs 19.8%; odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.02-1.17) and surgical subgroup (20.7% vs 13.3%; OR: 1.70, 95% CI: 1.37-2.11). Women undergoing surgery had more perioperative complications, including postcardiotomy cardiogenic shock (10.5% vs 7.8%) and de novo dialysis (13.5% vs 9.8%). Long-term mortality was lower in women, while women in the surgical subgroup had higher mortality (hazard ratio [HR]: 1.12, 95% CI: 1.01-1.25) and redo valve surgery rates (11.5% vs 8.1%; HR: 1.43; 95% CI: 1.07-1.90). Conclusions Women with IE had higher in-hospital mortality regardless of surgical intervention. Among those who underwent surgery, women experienced more perioperative complications compared with men. Although women exhibited superior overall late survival, those undergoing surgery had worse long-term outcomes. These findings highlight the need for improved sex-specific management, including early diagnosis, timely surgery, and extended follow-up.