RT Journal Article
T1 Neurological complications of infective endocarditis: risk factors, outcome, and impact of cardiac surgery: a multicenter observational study.
A1 García-Cabrera, Emilio
A1 Fernández-Hidalgo, Nuria
A1 Almirante, Benito
A1 Ivanova-Georgieva, Radka
A1 Noureddine, Mariam
A1 Plata, Antonio
A1 Lomas, Jose M
A1 Gálvez-Acebal, Juan
A1 Hidalgo-Tenorio, Carmen
A1 Ruíz-Morales, Josefa
A1 Martínez-Marcos, Francisco J
A1 Reguera, Jose M
A1 Torre-Lima, Javier de La
A1 Alarcón González, Arístides De
K1 Endocardium
K1 Infection
K1 Nervous system
K1 Complications
K1 Antiinfecciosos
K1 Absceso encefálico
K1 Isquemia encefálica
K1 Hemorragia cerebral
K1 Terapia combinada
K1 Comorbilidad
K1 Encefalitis
K1 Endocarditis
K1 Estudios de seguimiento
K1 Incidencia
K1 Aneurisma Intracraneal
K1 Meningitis
K1 Estudios multicéntricos como Asunto
K1 Complicaciones postoperatorias
K1 Pronóstico
K1 Modelos de riesgos Proporcionales
K1 Estudios retrospectivos
K1 Factores de riesgo
K1 Infecciones estafilocócicas
K1 Resultado del tratamiento
AB BACKGROUNDThe purpose of this study was to assess the incidence of neurological complications in patients with infective endocarditis, the risk factors for their development, their influence on the clinical outcome, and the impact of cardiac surgery.METHODS AND RESULTSThis was a retrospective analysis of prospectively collected data on a multicenter cohort of 1345 consecutive episodes of left-sided infective endocarditis from 8 centers in Spain. Cox regression models were developed to analyze variables predictive of neurological complications and associated mortality. Three hundred forty patients (25%) experienced such complications: 192 patients (14%) had ischemic events, 86 (6%) had encephalopathy/meningitis, 60 (4%) had hemorrhages, and 2 (1%) had brain abscesses. Independent risk factors associated with all neurological complications were vegetation size ≥3 cm (hazard ratio [HR] 1.91), Staphylococcus aureus as a cause (HR 2.47), mitral valve involvement (HR 1.29), and anticoagulant therapy (HR 1.31). This last variable was particularly related to a greater incidence of hemorrhagic events (HR 2.71). Overall mortality was 30%, and neurological complications had a negative impact on outcome (45% of deaths versus 24% in patients without these complications; P<0.01), although only moderate to severe ischemic stroke (HR 1.63) and brain hemorrhage (HR 1.73) were significantly associated with a poorer prognosis. Antimicrobial treatment reduced (by 33% to 75%) the risk of neurological complications. In patients with hemorrhage, mortality was higher when surgery was performed within 4 weeks of the hemorrhagic event (75% versus 40% in later surgery).CONCLUSIONSModerate to severe ischemic stroke and brain hemorrhage were found to have a significant negative impact on the outcome of infective endocarditis. Early appropriate antimicrobial treatment is critical, and transitory discontinuation of anticoagulant therapy should be considered.
PB American Heart Association
SN 0009-7322
YR 2013
FD 2013-06-11
LK http://hdl.handle.net/10668/1646
UL http://hdl.handle.net/10668/1646
LA en
NO García-Cabrera E, Fernández-Hidalgo N, Almirante B, Ivanova-Georgieva R, Noureddine M, Plata A, et al. Neurological complications of infective endocarditis: risk factors, outcome, and impact of cardiac surgery: a multicenter observational study. Circulation. 2013;127(23):2272-84
NO Journal Article;
DS RISalud
RD Apr 6, 2025