Impact of Surgical Valve Intervention on In-Hospital Outcomes in Candida Endocarditis: A Seven-Year Analysis.

Abstract

Candida endocarditis (CE) is a rare but highly lethal infection with limited evidence guiding its management. While surgical valve replacement or repair is often recommended, its impact on in-hospital outcomes remains unclear. We conducted a retrospective cohort study using the National Inpatient Sample (2016-2022) to identify adult admissions with CE. The primary exposure was surgical valve intervention. The primary outcomes were overall and 30-day in-hospital mortality, while the secondary outcomes included length of stay and hospitalization costs. We used multivariable logistic regression, Cox proportional hazards models, and two causal inference methods, propensity score matching (PSM) and inverse probability of treatment weighting (IPTW), to adjust for potential confounding. We identified 1,280 weighted CE hospitalizations, representing 0.77% of infective endocarditis cases. Among them, 228 patients (17.8%) underwent valve intervention, with a median time to surgery of 9.5 days (IQR = 15 days). Overall, in-hospital mortality was 18.8%, significantly lower in those who underwent surgery (8.3% vs. 21.1%; p < 0.001). Valve intervention was associated with reduced mortality across multivariable analysis (AOR 0.28; 95% CI: 0.13-0.55), PSM (OR_PSM 0.31; 95% CI: 0.13-0.66), IPTW (OR_IPTW 0.42; 95% CI: 0.25-0.71), and Cox models (AHR 0.13; 95% CI: 0.07-0.25). However, intervention was also linked to longer hospital stays (β = 1.86; 95% CI: 1.61-2.14) and higher costs (β = 2.10; 95% CI: 1.71-2.61). Surgical valve intervention in patients with CE was associated with significantly lower in-hospital mortality, but at the cost of longer hospital stays and increased resource utilization.