Direct and Indirect Impact of COVID-19 for Patients with Immune-Mediated Inflammatory Diseases: A Retrospective Cohort Study

Importance: Since the beginning of the Coronavirus Disease-19 (COVID-19) pandemic, Severe Acute Respiratory Syndrome-CoV-2 (SARS-CoV-2) infection has been a serious challenge for immune-compromised patients with immune-mediated inflammatory diseases (IMIDs). Objective: Our aim was to investigate the impact of COVID-19 in terms of risks of infection, hospitalization and mortality in a cohort of patients with rheumatoid arthritis (RA), psoriasis (PSO) or inflammatory bowel disease (IBD). Furthermore, we studied the impact of SARS-CoV-2 infection on the prescribed drug regimen in these patients. Methods: Through the record linkage between health information systems, a cohort of patients, ≥18 years old, assisted in the Lazio region and who had suffered from immune-mediated inflammatory diseases (RA, PSO, IBD) between 2007 and 2019, was identified. The risk of infection, hospitalization or mortality for COVID-19, was assessed by logistic regression models, and reported in an Odds Ratio (ORs; CI 95%), adjusting for sex, age and the Charlson Comorbidity Index. We also estimated these risks separately by IMID and in the subgroup of prevalent biologic drug users. We investigated deferral of biological treatments in the study population by comparing the prevalence of weekly use of biologicals (2019–2020) before and during the pandemic periods. Findings: Within the 65,230 patients with IMIDs, the cumulative incidence for COVID-19 was 303/10,000 ab. In this cohort of patients, we observed a significantly higher risk of SARS-CoV-2 infection than the general population: OR = 1.17 (95% CI 1.12–1.22). The risk was higher even considering separately each disease and in the subgroup of prevalent biologic drug users. This last subgroup of patients showed a higher risk of death related to COVID-19 (OR 1.89; 95% CI 1.04–3.33) than the general population. However, no differences in terms of risks of hospitalization or death related to COVID-19 were recorded in patients with the IMIDs. Comparing the 2019–2020 prevalence of weekly biological drug treatments in prevalent biologic drug users, we found a decrease (−19.6%) during the lockdown, probably due to pandemic restrictions. Conclusions and Relevance: Patients with IMIDs seem to have a higher risk of SARS-CoV2 infection. However, other than for patients with prevalent biologic drug treatment, no significant differences in terms of hospitalization and mortality were reported compared to the general populations; further investigation is warranted on account of unmeasured confounding. In addition, during the lockdown period, the COVID-19 emergency highlighted a lower use of biologic drugs; this phenomenon requires strict pharmacological monitoring as it could be a proxy of forthcoming long-term clinical progression.

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POS1180 TREATMENT COMPLIANCE OF PATIENTS WITH RHEUMATOID ARTHRITIS DURING THE FIRST WAVE OF THE SARS-CoV-2/COVID-19 PANDEMIC IN PORTUGAL: RESULTS FROM THE COVID IN RA (COVIDRA) SURVEY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1152 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 871.2-871

Author(s):

F. Araujo ◽

N. Gonçalves ◽

A. F. Mourão

Keyword(s):

Rheumatoid Arthritis ◽

Inflammatory Diseases ◽

Immunosuppressive Treatment ◽

Treatment Compliance ◽

Web Based ◽

Symptoms Of Depression ◽

Immune Mediated ◽

Attending Physician ◽

The Impact ◽

E Mail

Background:The outcomes of the infection by the SARS-CoV-2 in patients with immune-mediated inflammatory diseases were largely unknown during the early days of the COVID-19 pandemic. It was hypothesized that these patients were at higher risk of morbidity and mortality due to their inherent immune dysfunction and immunosuppressive therapy. Several rheumatology societies issued recommendations urging patients not to stop their anti-rheumatic treatments.Objectives:To assess treatment compliance of patients with rheumatoid arthritis (RA) during the first wave of the SARS-CoV-2/COVID-19 pandemic in Portugal.Methods:The web-based survey COVIDRA (COVID in RA) was developed to assess the impact of the first wave mandatory confinement in patients with RA focusing on 5 domains: RA symptoms, attitudes towards medication, employment status, physical exercise and mental health. The questionnaire was sent to RA patients through e-mail and social media of the Portuguese Society of Rheumatology and two patient associations; and it was filled locally at two rheumatology centers in Lisbon. Recruitment took place during June and July 2020. Descriptive statistics were generated by the survey software and were afterwards transported and evaluated using appropriate biostatistics software.Results:We obtained 441 valid questionnaires. Most respondents were female (88.4%), caucasian (93.6%), with a mean age of 58 (+/-13) years. The majority (57.6%) had longstanding disease (>10 years) and were treated with csDMARDs (63.2%) and/or bDMARDs/tsDMARDS (23,7%). Only 14% (N=61) discontinued or reduced the dosage or frequency of their RA treatment. Most of these changes were previously planned by the attending physician (27.9%). Only 11 patients (18%) discontinued their immunosuppressive medication out of fear of becoming infected with SARS-CoV-2 (corresponding to 2.5% of total responders). Another 11 patients did so because they had no prescription, couldn’t go to the community/hospital pharmacy or couldn’t afford the medication. Although these numbers preclude any statistical analysis, when compared to patients who persisted on their treatment, those discontinuing due to fear of contagion were younger (56.4 vs 58.5 years), all female (100 vs 86.8%), with long-lasting disease (≥ 11 years) (90.9% vs 57.5%), more frequently treated with bDMARDs (36.4 vs 23.1%) and presenting more symptoms of depression (54.5 vs 49.7%).Conclusion:Most RA patients complied with their treatment during the first wave of the SARS-CoV-2 pandemic in Portugal. Only a minority changed their immunosuppressive treatment due to fear of SARS-CoV-2 infection. Very similar rates of immunosuppressive discontinuation due to fear of contagion were reported by other authors (such as Schmeiser et al, Pineda-sic et al and Fragoulis et al).Disclosure of Interests:Filipe Araujo Speakers bureau: Pfizer, Biogen, Novartis, Menarini, Consultant of: MSD, Nuno Gonçalves: None declared, Ana Filipa Mourão: None declared.

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COVID-19 and rheumatology: A year later

Rheumatology Science and Practice ◽

10.47360/1995-4484-2021-31-36 ◽

2021 ◽

Vol 59 (1) ◽

pp. 31-36

Author(s):

B. S. Belov ◽

A. M. Lila

Keyword(s):

Clinical Trials ◽

General Population ◽

Severe Acute Respiratory Syndrome ◽

Inflammatory Diseases ◽

Controlled Clinical Trials ◽

Antirheumatic Drugs ◽

The Past ◽

Immune Mediated ◽

Great Hope ◽

Blind Spots

An enormous body of evidence on various aspects of the coronavirus disease 2019, COVID-19 associated with the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus-2) has been accumulated over the past year. Meanwhile, investigated relationship between COVID-19 and rheumatic immune-mediated inflammatory diseases (IMIDs) and certain identified similarities were of paramount importance. It was shown that the incidence of COVID-19 in patients with rheumatic diseases does not significantly differ from that in general population. The risk of severe course and unfavorable COVID-19 outcomes in patients with rheumatic IMIDs is significantly associated with older age and comorbidities – as in general population, and is not aggravated by preceding use of the majority of antirheumatic drugs. Gaining better insights into pathogenesis of COVID-19 provided sound prerequisites for anti-rheumatic drugs repurposing and substantiated their use for treatment of COVID-19 infection. Under current COVID-19 pandemic circumstances, accelerated development and invention of various COVID-19 vaccines offers a great hope to curb the tide of pandemic. However, the efficacy, immunogenicity, and safety of these vaccines in patients with rheumatic IMIDs must be studied in controlled clinical trials. Generally speaking, there are still numerous blind spots in our knowledge of rheumatological aspects of such a versatile and polymorphous condition as COVID-19 infection.

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Allopurinol initiation and all-cause mortality in the general population

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2014-205269 ◽

2014 ◽

Vol 74 (7) ◽

pp. 1368-1372 ◽

Cited By ~ 37

Author(s):

Maureen Dubreuil ◽

Yanyan Zhu ◽

Yuqing Zhang ◽

John D Seeger ◽

Na Lu ◽

...

Keyword(s):

General Population ◽

Propensity Score ◽

Adverse Effects ◽

Serum Urate ◽

Population Database ◽

General Population Study ◽

Risk Of Death ◽

All Cause Mortality ◽

Study Population ◽

The Impact

BackgroundAllopurinol is the most commonly used urate-lowering therapy, with rare but potentially fatal adverse effects. However, its impact on overall mortality remains largely unknown. In this study, we evaluated the impact of allopurinol initiation on the risk of mortality among individuals with hyperuricaemia and among those with gout in the general population.MethodsWe conducted an incident user cohort study with propensity score matching using a UK general population database. The study population included individuals aged ≥40 years who had a record of hyperuricaemia (serum urate level >357 μmol/L for women and >416 μmol/L for men) between January 2000 and May 2010. To closely account for potential confounders of allopurinol use and risk of death, we constructed propensity score matched cohorts of allopurinol initiators and comparators (non-initiators) within 6-month cohort accrual blocks.ResultsOf 5927 allopurinol initiators and 5927 matched comparators, 654 and 718, respectively, died during the follow-up (mean=2.9 years). The baseline characteristics were well balanced in the two groups, including the prevalence of gout in each group (84%). Allopurinol initiation was associated with a lower risk of all-cause mortality (matched HR 0.89 (95% CI 0.80 to 0.99)). When we limited the analysis to those with gout, the corresponding HR was 0.81 (95% CI 0.70 to 0.92).ConclusionsIn this general population study, allopurinol initiation was associated with a modestly reduced risk of death in patients with hyperuricaemia and patients with gout. The overall benefit of allopurinol on survival may outweigh the impact of rare serious adverse effects.

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Intestinal Microbiota: Facts and Fiction

Digestive Diseases ◽

10.1159/000449095 ◽

2017 ◽

Vol 35 (1-2) ◽

pp. 139-147 ◽

Cited By ~ 14

Author(s):

Miloslav Kverka ◽

Helena Tlaskalová-Hogenová

Keyword(s):

Inflammatory Diseases ◽

Research Directions ◽

Vast Number ◽

Chronic Inflammatory Diseases ◽

Immune Mediated ◽

Complex Ecosystem ◽

Microbe Interactions ◽

Host Microbe Interactions ◽

The Impact ◽

Number Of Bacteria

In humans, the gut microbiota forms a complex ecosystem consisting of a vast number of bacteria, Archaea, fungi and viruses. It represents a major stimulus to the development of the immune system and many other physiological functions, so that it may shape the individual's susceptibility to infectious and immune-mediated diseases. The emergence of new ‘-omics' methods recently revolutionized the way we study the host-microbe interactions, but they also raised new questions and issues. In this review, we discuss the impact of these new data on the current and future therapies for chronic inflammatory diseases. We also outline the major conceptual, technical and interpretational issues that recently led to some misleading conclusions and discuss in brief the current research directions in the field.

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A Brazilian Cohort of Patients With Immuno-Mediated Chronic Inflammatory Diseases Infected by SARS-CoV-2 (ReumaCoV-Brasil Registry): Protocol for a Prospective, Observational Study

JMIR Research Protocols ◽

10.2196/24357 ◽

2020 ◽

Vol 9 (12) ◽

pp. e24357

Author(s):

Claudia Marques ◽

Adriana Maria Kakehasi ◽

Ana Paula Monteiro Gomides ◽

Eduardo Dos Santos Paiva ◽

Edgard Torres dos Reis Neto ◽

...

Keyword(s):

Clinical Laboratory ◽

Inflammatory Diseases ◽

Progression Rate ◽

Immune Mediated ◽

Increased Risk ◽

Observational Cohort ◽

And Function ◽

The Impact ◽

Brazilian Cohort

Background Patients with immune-mediated rheumatic diseases (IMRD) are at increased risk of infections, including significant morbidity and high mortality. Considering the potential for unfavorable outcomes of SARS-CoV-2 infection in patients with IMRD, several questions were raised regarding the impact of COVID-19 at the start of the pandemic. Objective This paper presents the protocol of a study that aims to prospectively evaluate patients with IMRD and a confirmed COVID-19 diagnosis (using criteria provided by the Brazilian Ministry of Health). Methods The study comprised a prospective, observational cohort (patients with IMRD and COVID-19) and a comparison group (patients with only IMRD), with a follow-up time of 6 months to evaluate differences in health outcomes. The primary outcomes will be changes in IMRD disease activity after SARS-CoV-2 infection at 4 time points: (1) at baseline, (2) within 4-6 weeks after infection, (3) at 3 months after the second assessment (±15 days), and (4) at 6 months (±15 days). The secondary outcomes will be the progression rate to moderate or severe forms of COVID-19, need for intensive care unit admission and mechanical ventilation, death, and therapeutic changes related to IMRD. Two outcomes—pulmonary and thromboembolic events in patients with both IMRD and SARS-CoV-2 infection—are of particular interest and will be monitored with close attention (clinical, laboratory, and function tests as well as imaging). Results Recruitment opened in May 2020, with 1300 participants recruited from 43 sites as of November 2020. Patient recruitment will conclude by the end of December 2020, with follow-up occurring until April 2021. Data analysis is scheduled to start after all inclusion data have been collected, with an aim to publish a peer-reviewed paper in December 2020. Conclusions We believe this study will provide clinically relevant data on the general impact of COVID-19 on patients with IMRD. Trial Registration Brazilian Registry of Clinical Trials RBR-33YTQC; http://www.ensaiosclinicos.gov.br/rg/RBR-33ytqc/ International Registered Report Identifier (IRRID) DERR1-10.2196/24357

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Impact of changes in heart rate with age on all-cause death and cardiovascular events in 50-year-old men from the general population

Open Heart ◽

10.1136/openhrt-2018-000856 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000856 ◽

Cited By ~ 6

Author(s):

Xiao-jing Chen ◽

Salim Bary Barywani ◽

Per-Olof Hansson ◽

Erik Östgärd Thunström ◽

Annika Rosengren ◽

...

Keyword(s):

Heart Rate ◽

General Population ◽

Cardiovascular Events ◽

Population Sample ◽

Resting Heart Rate ◽

Risk Of Death ◽

Increased Risk ◽

Old Men ◽

The Impact ◽

Random Population Sample

BackgroundResting heart rate (RHR), a known cardiovascular risk factor, changes with age. However, little is known about the association between changes in RHR and the risk of cardiovascular events. The purpose of this study was therefore to assess the impact of RHR at baseline, and the change in RHR over time, on the risk of all-cause death and cardiovascular events.DesignA random population sample of men born in 1943 who were living in Gothenburg, Sweden was prospectively followed for a 21-year period.MethodsParticipants were examined three times: first in 1993 and then re-examined in 2003 and 2014. At each visit, a clinical examination, an ECG and laboratory analyses were performed. Change in RHR between 1993 and 2003 was defined as a decrease if RHR decreased by 5 beats per minute (bpm), an increase if RHR increased by 5 bpm or stable if the RHR change was <4bpm).ResultsParticipants with a baseline RHR of >75 bpm in 1993 had about a twofold higher risk of all-cause death (HR 2.3, CI 1.2 to 4.7, p=0.018), cardiovascular disease (CVD) (HR 1.8, CI 1.1 to 3.0, p=0.014) and coronary heart disease (CHD) (HR 2.2, CI 1.1 to 4.5, p=0.025) compared with those with <55 bpm in 1993. Participants with a stable RHR between 1993 and 2003 had a 44% decreased risk of CVD (HR 0.56, CI 0.35 to 0.87, p=0.011) compared with participants with an increasing RHR. Furthermore, every beat increase in heart rate from 1993 was associated with a 3% higher risk for all-cause death, 1% higher risk for CVD and 2% higher risk for CHD.ConclusionHigh RHR was associated with an increased risk of death and cardiovascular events in men from the general population. Moreover, individuals with an increase in RHR between 50 and 60 years of age had worse outcome.

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Can the surgeon live his whole life? Analysis of the risk of death related to the profession

Polish Journal of Surgery ◽

10.5604/01.3001.0011.5955 ◽

2018 ◽

Vol 90 (1) ◽

pp. 18-24 ◽

Cited By ~ 1

Author(s):

Kryspin Mitura ◽

Sławomir Kozieł ◽

Klaudiusz Komor

Keyword(s):

General Population ◽

Life Expectancy ◽

Tertiary Education ◽

University Education ◽

Average Lifetime ◽

Average Life ◽

Average Life Expectancy ◽

Risk Of Death ◽

Average Lifespan ◽

The Impact

More than half of physicians in Poland are over 50 years old. This raises concerns about the risk of lack of continuity of health care services due to the generational gap, particularly marked among interventional specialties. The physical and mental burden of general surgery affects those doctors in particular. The aim of the study is to assess whether the type of the profession pursued influences the average lifetime of a physician in Poland and the impact of the surgeon’s occupation on life expectancy compared to the rest of the population according to gender. Demographic data was obtained from official publications of the Central Statistical Office. Data on 189,459 physicians in Poland were obtained from the Central Register of Doctors. A total of 6,496 physicians and dentists deaths in the period from January 1st, 2010 to June 30th, 2014, including 722 surgeons, were analyzed. In general, both male physicians and dentists died at an older age than the mean population (74.9 years and 74.7 years vs. 68.9 years; p <0.05). Among women, only dentists lived longer (78.5 years) p <0.05), while women physicians died at a younger age than the average in the general population (76.4 vs. 77.2 years; p <0.05). The average lifetime of both male and female surgeons was 74.2 and 77.5 years, respectively. The average life expectancy of people aged 25 years with college/university education is 80.3 years for men and 86.6 years for women. Male surgeons live significantly longer than the average life expectancy in the general population of men. The average length of life of women surgeons is significantly lower than the average lifespan of women in the general population. The actual lifetime of surgeons in Poland is significantly lower than the expected average life expectancy for other people aged 25 with tertiary education. The average lifespan of surgeons in Poland does not differ significantly from the average life expectancy of other Polish physicians.

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Systematic review and meta-analysis: the impact of co-occurring immune-mediated inflammatory diseases on the disease localization and behavior of Crohn’s disease

Therapeutic Advances in Gastroenterology ◽

10.1177/17562848211004839 ◽

2021 ◽

Vol 14 ◽

pp. 175628482110048

Author(s):

Mohamed Attauabi ◽

Mirabella Zhao ◽

Flemming Bendtsen ◽

Johan Burisch

Keyword(s):

Systematic Review ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Inflammatory Diseases ◽

Meta Analysis ◽

Random Effect ◽

Immune Mediated ◽

Increased Risk ◽

The Impact ◽

Upper Gastrointestinal

Background: Patients with Crohn’s disease (CD) are at increased risk of co-occurring immune-mediated inflammatory diseases (IMIDs). As discrepancy exists regarding the phenotypic presentation of CD among patients with such co-occurring IMIDs, we aimed to conduct a systematic review with meta-analysis characterizing the phenotype of CD among this subgroup of patients. Methods: PubMed, Embase, and Scopus were searched from their earliest records to October 2019 for studies reporting the behavior and localization of CD according to the Vienna or Montreal Classifications and CD-related surgery in patients with co-occurring IMIDs. These studies were the subject of a random effect meta-analysis. Results: After reviewing 24,413 studies, we identified a total of 23 studies comprising 1572 and 35,043 CD patients with and without co-occurring IMIDs, respectively, that fulfilled our inclusion criteria. Overall, patients with co-occurring IMIDs were more likely to have upper gastrointestinal inflammation than were patients without co-occurring IMIDs [relative risk (RR) = 1.49 (95% confidence interval (CI) 1.09–2.04), p = 0.01, I2 = 7%]. In addition, presence of primary sclerosing cholangitis (PSC) was associated with a lower occurrence of ileal affection [RR = 0.44 (95% CI 0.24–0.81), p < 0.01, I2 = 32%], increased occurrence of colonic affection [RR = 1.78 (95% CI 1.33–2.38), p < 0.01, I2 = 32%] and an increased likelihood of non-stricturing and non-penetrating behavior [RR = 1.43 (95% CI 0.97–2.11), p = 0.07, I2 = 86%]. The latter reached significance when cumulating different IMIDs [RR = 1.30 (95% CI 1.09–1.55), p < 0.01, I2 = 88%]. CD patients with PSC also underwent fewer CD-related surgeries [RR = 0.55 (95% CI 0.34–0.88), p = 0.01, I2 = 0%], irrespective of CD location or behavior. Conclusion: This study emphasizes that CD patients with co-existing PSC are likely to have a unique inflammatory distribution primarily confined to the colon, while patients with IMIDs in general have higher likelihood of affection of upper gastrointestinal tract and a non-stricturing and non-penetrating behavior. As such a phenotype of CD is typically associated with a milder disease course; future studies are needed to confirm these results.

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Long-term cause-specific mortality in hodgkin lymphoma patients

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa194 ◽

2020 ◽

Author(s):

Simone de Vries ◽

Michael Schaapveld ◽

Cécile P M Janus ◽

Laurien A Daniëls ◽

Eefke J Petersen ◽

...

Keyword(s):

General Population ◽

Hodgkin Lymphoma ◽

Primary Treatment ◽

Subdistribution Hazard ◽

Cumulative Mortality ◽

Risk Of Death ◽

Disease Mortality ◽

Specific Mortality ◽

The Impact

Abstract Background Few studies examined the impact of treatment-related morbidity on long-term cause-specific mortality in Hodgkin lymphoma (HL) patients. Methods This multicenter cohort included 4,919 HL patients, treated before age 51 between 1965–2000, with a median follow-up of 20.2 years. Standardized mortality ratios (SMRs), absolute excess mortality per 10,000 person-years (AEM) and cause-specific cumulative mortality by stage and primary treatment, accounting for competing risks were calculated. Results HL patients experienced 5.1-fold (AEM = 123 excess deaths per 10,000 person-years) higher risk of death due to causes other than HL. This risk remained increased in 40-year survivors (SMR = 5.2, 95% Confidence Interval (95%CI) = 4.2–6.5; AEM = 619). At age 54 years, HL survivors experienced similar cumulative mortality (20.0%) from causes other than HL as 71-year old individuals from the general population. While HL mortality statistically significantly decreased over calendar period (p < .001), solid tumor mortality did not change in the most recent treatment era. Patients treated in 1989–2000 had lower 25-year cardiovascular disease mortality than patients treated in 1965–1976 (4.3% vs. 5.7%; subdistribution Hazard Ratio (HR) = 0.65, 95%CI = 0.46–0.93). Infectious disease mortality was not only increased after splenectomy but also after spleen irradiation (HR = 2.81, 95%CI = 1.55–5.07). For stage I-II, primary treatment with chemotherapy alone was associated with statistically significantly higher HL mortality (p < .001 for CT vs. RT; p = .04 for CT vs. RT+CT), but lower 30-year mortality from causes other than HL (15.8%, 95%CI = 9.7%–23.3%), compared to radiotherapy alone (36.9%, 95%CI = 34.0%–39.8%; p = .001) and radiotherapy and chemotherapy combined (29.8%, 95%CI = 26.8%–32.9%; p = .02). Conclusion Compared to the general population, HL survivors have a substantially reduced life expectancy. Optimal selection of patients for primary CT is crucial, weighing risks of HL relapse and long-term toxicity.

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Outcomes after Surgery for Endocarditis among Intravenous Drug Users and Nonusers

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1727231 ◽

2021 ◽

Author(s):

Antti Huuskonen ◽

Risto Kesävuori ◽

Peter Raivio

Keyword(s):

General Population ◽

Drug Users ◽

University Hospital ◽

Intravenous Drug ◽

Intravenous Drug Users ◽

Risk Of Death ◽

Increased Risk ◽

Reoperation Rates ◽

Early Reoperation ◽

Age And Sex

Abstract Background The optimal treatment strategy for intravenous drug users (IVDU) with infective endocarditis (IE) is controversial. We therefore sought to investigate outcomes among IVDUs after surgery for IE. Methods We retrospectively reviewed all 192 consecutive patients who underwent an operation for IE between 2005 and 2016 in the Helsinki University Hospital. Forty-seven patients (24.5%) were IVDUs and 145 (75.5%) were non-IVDUs. Mortality and reinfection and reoperation rates were evaluated. Results IVDUs were younger (29.9 vs. 63.8 years, p < 0.001) and had less cardiovascular risk factors and lower EuroSCORE II (4.3 vs. 7.3%, p < 0.001), but Staphylococcus aureus infection (66.0 vs. 23.4%, p < 0.001), tricuspid valve endocarditis (34.0 vs. 2.8%, p < 0.001), and liver disease (63.8 vs. 2.8%, p < 0.001) occurred more often in IVDUs than in non-IVDUs. Thirty-day mortality of IVDUs was 8.5% and that of non-IVDUs was 6.9% (p = 0.711). Survival of IVDUs at 5 years was 70.8 ± 7.4% and survival of non-IVDUs was 67.9 ± 4.7% (p = 0.678). Relative to an age- and sex-matched general population, IVDUs had 58.6 (95% confidence interval [CI]: 33.7–101.9; p < 0.001) and non-IVUD 4.4 (95% CI: 3.1–6.2; p < 0.001) standardized mortality ratio. IVDUs had a higher reinfection rate at 5 years (25.8 ± 7.7% vs. 3.0 ± 1.7%, p < 0.001) and a higher early reoperation rate than non-IVDUs (10.6 vs. 1.4%, p = 0.003). Conclusions IVDUs and non-IVDUs had comparable survival at 5 years, but IVDUs had a very significantly increased risk of death in comparison to an age- and sex-matched general population. IVDUs had higher reinfection and early reoperation rates. Survival was poor after medically treated reinfection.

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