Procedural and clinical risk factors of infective endocarditis – A nationwide case-control study in South Korea

Abstract

Background: Infective endocarditis (IE) causes high mortality and morbidity, posing a significant burden on healthcare systems. Although the incidence of IE is rising globally, its risk factors, particularly procedure-related risks, remain unclear. This study aimed to investigate the clinical and procedural risk factors associated with IE using nationwide data from South Korea.

Methods: We analyzed data from the Korean National Health Insurance Service between 2003 and 2018. A total of 8487 patients with IE and 33,535 matched controls based on age, sex, and the Charlson Comorbidity Index were included. Procedural risk factors were categorized as dental, gastrointestinal, respiratory, and genitourinary, with analysis periods of 90 and 60 days for dental and other procedures, respectively. Logistic regression models were used to evaluate the associations, with statistical significance set at P < 0.05.

Results: Traditional risk factors including dialysis, immunosuppression, congenital heart disease, and valvular disease were significantly associated with IE. Additionally, invasive procedures, such as intravenous catheter insertion (odds ratio [OR], 18.94) and respiratory (OR, 4.05), gastrointestinal (OR, 3.09), and genitourinary procedures (OR, 3.97), were strongly associated with an increased risk of IE (all P < 0.001). Dental procedures without antibiotic prophylaxis were also associated with a higher risk of IE (OR, 1.19; P = 0.001), whereas those with prophylaxis were not (OR, 1.07; P = 0.256).

Conclusions: Both clinical factors and procedural interventions significantly contributed to the risk of IE. Our findings support the need for expanded preventive strategies, particularly considering nondental invasive procedures and high-risk patient groups.