TABLE 2 : Baseline Characteristics of 444 Admissions for Infective Endocarditis . Characteristic
Non-PWID-IE ( n = 172 )
PWID-IE ( n = 272 )
P-Value
Median Age , Years 61 [ 30 ] 34 [ 14 ] < 0.001
Sex Assigned at Birth , % 0.08 Female 53.5 ( 92 ) 61.8 ( 168 ) Male 46.5 ( 80 ) 38.2 ( 104 )
Insurance , % < 0.001 Medicaid 32.0 ( 55 ) 79.8 ( 217 ) Medicare 50.0 ( 86 ) 11.4 ( 31 ) Private 15.1 ( 26 ) 5.9 ( 16 ) Work Comp 0.58 ( 1 ) 0 ( 0 ) None 2.3 ( 4 ) 2.9 ( 8 )
Smoking Status , % < 0.001 None 38.9 ( 67 ) 14.0 ( 38 ) Current 33.7 ( 58 ) 81.2 ( 221 ) Former 27.3 ( 67 ) 14.0 ( 38 ) Alcohol Use , % 5.8 ( 10 ) 10.7 ( 1 ) 0.130 Diabetes Mellitus , % 48.8 ( 84 ) 13.6 ( 37 ) < 0.001 Hypertension , % 77.3 ( 133 ) 34.9 ( 95 ) < 0.001 Congestive Heart Failure , % 41.9 ( 72 ) 15.4 ( 42 ) < 0.001 Chronic Kidney Disease , % 36.0 ( 62 ) 9.9 ( 27 ) 0.004 Median Length of Stay , Days 8 [ 9 ] 5 [ 8.5 ] 0.004 Median Hospital Charges , $ 63,132 [ 92,171 ] 57,724 [ 62,670 ] 0.36 Median Charges / Day , $ 9,189 [ 5,872 ] 10,400 [ 8,494 ] 0.02 Any Readmission , % 9.9 ( 17 ) 10.7 ( 29 ) 0.790
Admitting vitals , lab results , HCV antibody results , and HIV screening results are reported in Table 3 .
Cases that did not meet the criteria for opioid use were described as “ non-PWID- IE ” ( n = 172 ). Cases that met the criteria for opioid use were described as “ PWID-IE ” ( n = 272 ). Numbers in parentheses represent the total N . Numbers in brackets represent the interquartile range ( IQR ). BP = Blood Pressure ; WBC = White Blood Cells ; Hb = Hemoglobin ; BUN = Blood Urea Nitrogen ; AST = Aspartate Aminotransferase ; ALT = Alanine Aminotransferase ; CRP = C-Reactive Protein ; ESR = Erythrocyte Sedimentation Rate ; HIV = Human Immunodeficiency Virus .
Differences in systolic blood pressure ( SBP ) upon admission were significantly different between the groups ( P = 0.01 ), with PWID-IE having a lower SBP ( Median 119 mmHg ; IQR 27 mmHg ) than non-PWID-IE ( Median 125 mmHg ; IQR 31 mmHg ). Admitting temperature was also significant between the two groups ( P = 0.02 ); PWID-IE had higher temperatures ( Median 98.5 ° F ; IQR 1.7 ° F ) when compared to non-PWID-IE ( Median 98.2 ° F ; IQR 1.0 ° F ).
Lab results revealed several significant differences between PWID-IE and non- PWID-IE . Platelet counts in PWID-IE were significantly lower than in non-PWID- IE ( P = 0.02 ). Non-PWID-IE reported elevated creatinine ( P = 0.002 ) and blood urea nitrogen ( BUN , P < 0.001 ) levels when compared to PWID-IE . Aspartate transaminase ( AST , P = 0.02 ), alanine transaminase ( ALT , P = 0.03 ), and total protein
( P = 0.002 ) levels were significantly higher in PWID-IE than in non-PWID-IE , and albumin levels ( P < 0.01 ) were significantly lower in PWID-IE than in non-PWID-IE .
Differences in screenings for HCV antibodies ( P < 0.001 ) and HIV ( P < 0.001 ) were also significant between the two groups . PWID-IE had a greater percentage of patients who tested positive for HCV antibodies ( 79.4 %) than non-PWID-IE ( 15.1 %). The percentage of patients who tested positive for HIV was also higher in PWID- IE ( 4.4 %) than in non-PWID-IE ( 1.2 %).
Echocardiographic information was available on 336 patients ( 75.6 %). TTE was performed as the initial echocardiographic test in 94.0 % of these patients ( n = 316 ), which did not differ by opioid use ( 94.9 PWID-IE vs . 91.9 % non-PWID- IE , P = 0.28 ). Initial TTE identified an endovascular mass in 50.9 % of patients ( n = 161 / 316 ), while an initial TEE identified an endovascular mass in 70.0 % of patients ( n = 14 / 20 ). Endovascular mass location was primarily right-sided on the tricuspid valve in PWID-IE ( 60.5 vs . 32.1 % non- PWID-IE ; P = 0.004 ).
DISCUSSION
The purpose of this study was to determine the number of IE cases by opioid use in our community over time . Our findings reveal that annual admissions for IE at CHH significantly increased throughout the past decade in the study timeframe . PWID-IE comprised a majority ( 61.3 %) of total IE cases , and there was an increase in PWID- IE cases from 2010 to 2019 . This increase was particularly notable in the years 2017- 2019 where the odds of PWID-IE were anywhere from five to 19 times that of non- PWID-IE compared to the baseline year of 2010 . Our findings are similar to local and national studies that observed an increase in PWID-IE alongside increases in IDU and the opioid epidemic throughout the past decade . 3 , 4 , 5 , 6 , 10
The results of this study suggest that PWID-IE admitted to CHH were generally younger and more commonly female . However , when controlling for age ( less than 50 versus 50 and older ), gender was evenly balanced in PWID-IE , indicating that a large portion of our sample consisted
West Virginia Medical Journal • September 2024 • 17