Sex Disparities in Mortality and Clinical Characteristics in Patients with Infective Endocarditis: A Meta-Analysis of...

Sex disparities in the clinical presentation, management, and outcomes of infective endocarditis (IE) remain inconsistent throughout the literature. We aimed to investigate the prognostic impact of sex-associated disparities in all-cause mortality and baseline clinical characteristics among patients with IE.

We comprehensively searched PubMed, Scopus, Embase, and Web of Science till July 2025 for studies reporting sex-specific data on clinical presentation, mortality, and management patterns in IE. We reconstructed individual patient data from published Kaplan-Meier plots for all-cause mortality and estimated HR with 95% CI using a Cox regression model. Data regarding clinical presentation, microbiological profile, and management were pooled using random-effects meta-analysis.

Eighteen studies comprising 12,594 female and 24,365 male patients were included. Female sex was associated with a higher risk of mortality (HR: 1.338, 95% CI: 1.272-1.407, p < 0.001). Women more often had mitral valve endocarditis and valve vegetations but less frequently aortic valve endocarditis and intracardiac abscesses. Rates of surgical indication were similar between sexes, yet women underwent surgery less often, coinciding with higher baseline EuroScore II. Enterococcal infections were less common in women, with no significant sex differences for other microbiological etiologies.

Women with IE experience higher mortality than men despite similar surgical indications, alongside distinctive valve involvement patterns, higher baseline surgical risk, and lower surgical intervention rates. Earlier recognition, timely intervention, and optimized surgical decision-making in women may help reduce this disparity.