Characteristic Admitting Vitals
Table 3 . Admitting Vitals , Lab Results , and HCV / HIV Screening Results of 444 Admissions with Infective Endocarditis .
Non-PWID-IE ( n = 172 )
PWID-IE ( n = 272 )
P-Value
Median Systolic BP , mmHg 125 [ 31 ] 119 [ 27 ] 0.01 Median Diastolic BP , mmHg 70 [ 20 ] 71 [ 22 ] 0.87 Median Respiratory Rate 18 [ 4 ] 19 [ 6 ] 0.054 Median SpO2 , % 97.5 [ 4 ] 98 [ 3 ] 0.141 Median Temperature (° F ) 98.2 [ 1 ] 98.5 [ 1.7 ] 0.02
Admitting Lab Results Median Procalcitonin ( ng / mL ) 3.0 [ 18.5 ] 3.4 [ 15.5 ] 0.66 Median WBC ( k / cmm ) 11.2 [ 7.3 ] 11.6 [ 8.5 ] 0.72 Median Hb ( g / dL ) 11.0 [ 3.1 ] 11.4 [ 3.2 ] 0.37 Median Platelets ( k / cmm ) 182.0 [ 163 ] 162.5 [ 152 ] 0.02 Median Creatinine ( mg / dL ) 1.15 [ 1.27 ] 0.93 [ 0.86 ] 0.002 Median BUN ( mg / dL ) 21 [ 28 ] 18 [ 22 ] < 0.001 Median AST ( units / L ) 25 [ 36 ] 34 [ 42 ] 0.02 Median ALT ( units / L ) 22 [ 22 ] 27 [ 29 ] 0.03 Median Total Protein ( g / dL ) 6.7 [ 1.3 ] 7.0 [ 1.4 ] 0.002 Median Albumin ( g / dL ) 3.0 [ 1.3 ] 2.6 [ 1.1 ] < 0.001 Median Total Bilirubin ( mg / dL ) 0.6 [ 0.5 ] 0.6 [ 0.6 ] 0.61 Median CRP ( mg / dL ) 17.8 [ 14.9 ] 15.4 [ 12.7 ] 0.88 Median ESR ( mm / h ) 57.5 [ 53 ] 52.5 [ 49.5 ] 0.31
Hepatitis C Virus Antibody , % ( N ) Positive 15.1 ( 26 ) 79.4 ( 216 ) < 0.001 Negative 27.3 ( 47 ) 12.1 ( 33 ) Equivocal 0 ( 0 ) 0.37 ( 1 ) Not Tested 57.6 ( 99 ) 8.1 ( 22 )
HIV , % ( N ) Positive 1.2 ( 2 ) 4.4 ( 12 ) < 0.001 Negative 26.2 ( 45 ) 79.0 ( 215 ) Not Tested 72.7 ( 125 ) 16.5 ( 45 ) care in newly seropositive patients .
Differences in median length of stay between PWID-IE ( 5 days ) and non-PWID- IE ( 8 days ) could possibly be explained by the relatively high proportion of AMA discharges in PWID-IE . Between 5-22 % of PWID-IE admissions result in AMA discharges , compared to 1-2 % among other IE patients . 6 Because SUDs are often inadequately treated during hospital admissions , a patient ’ s withdrawal symptoms may impact their decision to leave AMA . 6 As such , it is important that providers recognize the importance of treating a patient ’ s underlying SUD in the setting of PWID-IE to improve clinical outcomes .
Of significant note is that a majority of patients ( 98.3 %) in this study were covered by some form of medical insurance . This could be attributable to the Affordable Care Act , which was enacted into law in 2010 . 14 However , this could also be due to patients with insurance being more likely to seek medical care than those without insurance . Although differences in total hospital charges were not significant between the two groups , PWID-IE were charged a greater amount per day than non-PWID-IE . A review of medical records in future studies will be helpful in elucidating the causes of such differences .
Procalcitonin and white blood cell ( WBC ) levels were elevated in both groups , indicating systemic infection upon admission . C-reactive protein and erythrocyte sedimentation rate levels were also elevated in both groups , indicating inflammatory responses in both patient groups . These findings are consistent with clinical presentations for IE-associated infections . 1 of females who were less than 50 years old . These findings are consistent with national epidemiological trends in cases of PWID-IE , which indicate that patients are younger and are evenly distributed by sex assigned at birth . 5
Differences in comorbidities between the patient groups are likely due to several factors . Non-PWID-IE displayed higher rates of diabetes , hypertension , congestive heart failure , and chronic kidney disease , likely in part due to this patient group ’ s older age . Both older age and comorbid health conditions are known risk factors for IE . 1 , 2 PWID-IE displayed greater rates of positivity for HCV antibodies and HIV , both of which are comorbidities commonly seen in PWID . 5 Based on the rates of HCV and HIV positivity , particularly in PWID-IE , all patients with IE should be tested for HCV and HIV . Although we were unable to confirm what percentage of patients had new HCV and / or HIV seropositivity , testing for HCV and HIV during IE admission serves as an opportunity for improved linkage of
Platelet counts were within the lower limits of normal for both groups . PWID-IE reported significantly lower platelet levels , suggesting that these patients possibly presented with more severe infections . Both groups reported abnormally low albumin levels , and PWID-IE had significantly lower albumin levels compared to non-PWID-IE . Albumin has historically been known as a marker that is indicative of inflammation , malnutrition , or liver disease , and low albumin levels positively correlate with increased mortality . 15 , 16 This
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