BACTERIAL-ENDOCARDITIS IN PATIENTS WITH CHRONIC LIVER-DISEASE

Objective: Although patients with cirrhosis have an increased suscepti bility for bacterial infections, endocarditis complicating cirrhosis h as been reported only infrequently. In this study, our objective was t o determine whether, bacterial endocarditis is, in fact, a complicatin g factor in cirrhosis. Methods: We retrospectively studied all cases o f bacterial endocarditis that occurred over the last 15 yr in patients with known cirrhosis. Results: Ten patients (three males, seven femal es) were identified, whose mean age was 55 yr (range 29-65 yr). Bacter ial organisms included Staphylococcus aureus, coagulase-positive (eigh t patients), Peptostreptococcus (one patient), and Enterococcus (one p atient). Underlying liver disease consisted of alcoholism (five patien ts), autoimmune chronic active hepatitis (two), cryptogenic cirrhosis (two), and primary biliary cirrhosis (one). Distribution of heart valv es affected were mitral valve (six), aorta (two), and there were two i nvolving both mitral and aortic valves. Echocardiograms revealed veget ation in 50% of the patients. Laboratory studies were markedly abnorma l, with mean values of albumin 2.4 mg/dl, creatinine 2.5 mg/dl, BUN 76 .5 mg/dl, and total bilirubin 8.2 mg/dl. Potential associated sources of infection were upper gastrointestinal bleeding (four), pneumonia (t wo), and one each of spontaneous bacterial peritonitis, hip replacemen t, heart catheterization, and abdominal abscess. The outcome was poor, with death in eight of 10 patients. Conclusions: Bacterial endocardit is may complicate cirrhosis, may be more frequent in females, typicall y involves the mitral valve, and probably is due to Staphylococcus aur eus.