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Clinical Research

Impact of preoperative body mass index on postoperative outcomes in infective endocarditis: a multicenter analysis of 4801 consecutive patients

International Journal of Obesity (2025)Cite this article

Subjects

Abstract

Background

The impact of body weight disorders on outcomes of patients undergoing cardiac surgery for infective endocarditis (IE) have been poorly studied. Obesity or malnutrition may significantly influence the course and prognosis of endocarditis, driven by distinct comorbidities and microbiological profiles. Hence, we investigated the impact of preoperative body mass index (BMI) on postoperative outcomes in a large multicentric cohort of surgically treated IE patients.

Methods

Data from the Clinical Multicenter Project for Analysis of Infective Endocarditis in Germany (CAMPAIGN) registry (n = 4917) was used for retrospective analysis. The patients were divided into four groups for comparison according to their BMI: (1) underweight (≤18.5 kg/m2), (2) normal-weight (18.6–24.9 kg/m2), (3) overweight (25.0–29.9 kg/m2), (4) obesity (≥30.0 kg/m2). Patients with incomplete data on body weight or height were excluded (n = 116). The primary outcomes were 30-day and 1-year mortality.

Results

The final study cohort comprised 4801 patients, including 133 underweight patients (2.8%), 1884 normal-weight patients (39.2%), 1797 patients with overweight (37.4%), and 987 patients with obesity (20.6%). The mean age in the entire cohort was 65.0 [54.0–73.0] years. Patients with obesity had more comorbidities, including hypertension (63.0%; p < 0.001), diabetes mellitus (45.7%, p < 0.001), coronary artery disease (29.5%; p < 0.001), previous cardiac surgery (32.2%, p < 0.012) and dialysis-dependent chronic kidney disease (11.6%, p < 0.001). Patients with obesity had the highest prevalence of staphylococcal endocarditis (33.4%; p < 0.001), while underweight patients had more streptococcal infection (22.0%; p < 0.001). Patients with obesity had the worst 30-day and 1-year mortality rates after surgery for IE (14.1% and 19.6%, p < 0.001 and p < 0.001 respectively).

Conclusions

IE patients with obesity present with comorbidities, higher 30-day mortality and lower 1-year survival rates, possibly linked to more frequent staphylococcal infections and comorbidities. This emphasises the need for early risk stratification, enhanced infection prevention and improved perioperative care in patients with obesity.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Author information

Author notes

  1. These authors contributed equally: Ahmed Elderia, Carolyn Weber.

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany

    Ahmed Elderia, Carolyn Weber, Thorsten Wahlers, Maximilian Luehr & Maximilian Luehr

  2. Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany

    Shekhar Saha, Christian Hagl, Christian Hagl & Sekhar Saha

  3. German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany

    Shekhar Saha & Christian Hagl

  4. University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany

    Martin Misfeld, Mateo Marin-Cuartas, Michael A. Borger, Michale Borger, Martin Misfeld & Mateo-Marin Cuartas

  5. Deparmtent of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Martin Misfeld

  6. Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany

    Mahmoud Diab, Torsten Doenst, Hirsto Kirov & Tulio Caldonazo

  7. Helios University Department of Cardiac Surgery, Wuppertal, Germany

    Mahmoud Diab & Mahmoud Diab

  8. Department of Cardiac Surgery, University Hospital, University of Dresden, Dresden, Germany

    Asen Petrov, Sems-Malte Tugtekin, Klaus Matschke & Malte Tugtekin

  9. Department of Cardiac Surgery, Heinrich Heine University, Dusseldorf, Germany

    Hug Aubin, Artur Lichtenberg & Mohammed Morjan

  10. Department of Thoracic and Cardiovascular Surgery, University of Essen, Essen, Germany

    Payam Akhyari

Authors
  1. Ahmed Elderia
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  8. Sems-Malte Tugtekin
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  16. Michael A. Borger
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  17. Maximilian Luehr
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Consortia

On behalf of the study group “Clinical, Multicenter Project of Analysis of Infective Endocarditis in Germany” (CAMPAIGN)

  • Carolyn Weber
  • , Maximilian Luehr
  • , Ahmed Elderia
  • , Michale Borger
  • , Martin Misfeld
  • , Mateo-Marin Cuartas
  • , Christian Hagl
  • , Sekhar Saha
  • , Torsten Doenst
  • , Hirsto Kirov
  • , Tulio Caldonazo
  • , Klaus Matschke
  • , Malte Tugtekin
  • , Asen Petrov
  • , Artur Lichtenberg
  • , Hug Aubin
  • , Mohammed Morjan
  • , Payam Akhyari
  •  & Mahmoud Diab

Contributions

AE, CW and ML conceived and supervised the study. AE, CW, SS, MM, MMC, MD, AP, SMT, PA and ML collected and analyzed data of patients with infective endocarditis. AE, CW and ML drafted the article. KM, TD, CH, AL, TW, MAB supervised data collection and interpreted data. SS, MM, MMC, MD, AP, SMT, HA, PA, KM, TD, CH, AL, TW and MAB revised the manuscript critically for important intellectual content. AE, CW and ML performed statistical analyses. All authors agreed to be accountable for their contributions of the work in ensuring that questions related to the accuracy or integrity of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Ahmed Elderia.

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Competing interests

MAB discloses that his hospital receives speakers’ honoraria and/or consulting fees on his behalf from Edwards Lifesciences, Medtronic, Abbott, and Artivion. The remaining authors have no conflicts of interest or financial relationships with the industry to disclose.

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Elderia, A., Weber, C., Saha, S. et al. Impact of preoperative body mass index on postoperative outcomes in infective endocarditis: a multicenter analysis of 4801 consecutive patients. Int J Obes (2025). https://doi.org/10.1038/s41366-025-01901-7

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  • DOI: https://doi.org/10.1038/s41366-025-01901-7

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