Sex-based differences in mortality and prognostic factors for infective endocarditis: insights from a retrospective cohort of 519 patients

ABSTRACT Introduction Infective endocarditis (IE) remains a severe disease with high mortality despite advances in management. Although it predominantly affects male patients, female patients account for about one-quarter of cases. Sex-specific differences in outcomes and prognostic factors remain insufficiently explored. Methods We conducted a retrospective study including 519 patients ≥16 years hospitalized for definite or possible IE (ESC 2023 criteria) at La Timone Hospital, Marseille, between March 2019 and October 2023. The primary endpoint was one-year mortality; secondary endpoints included surgical management, valve involvement, and prognostic factors. Results Of the 519 patients, 26% were female patients. One-year mortality was comparable between sexes (27% in female patients vs. 23% in male patients, p = 0.415). Post-discharge mortality was not significantly different between sexes ( p = 0.096). Mitral valve involvement was more frequent in female patients, and aortic involvement predominated in male patients. Independent predictors of mortality included annular complications and lack of surgery. Importantly, sex-specific differences in prognostic factors were observed in this exploratory analysis: in female patients, TAVI and ischemic heart disease were associated with higher mortality; in male patients, right-sided IE and pacemaker presence were predictive. Furthermore, fatal cases in male patients were marked by more in-hospital complications (heart failure, cardiogenic or septic shock, acute renal failure), suggesting distinct mortality pathways. Conclusion Although overall mortality was similar between sexes, male patients and female patients with IE appeared to show different prognostic profiles in this single-center cohort. These preliminary, hypothesis-generating findings suggest that some established risk factors may largely reflect male data, emphasizing the need for larger, multicenter studies to confirm sex-specific determinants and improve individualized management.