Neurological Complications of Infective Endocarditis: Risk Factors, Outcome, and Impact of Cardiac Surgery: A Multicenter Observational Study
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Background—: The 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 Results—: This 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). Conclusions—: Moderate 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.
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In a multicenter study of patients with hemorrhagic stroke, mortality was higher when surgery was performed within 4 weeks of the hemorrhagic event compared with later surgery (75% versus 40%).
“In a multicenter study of patients with hemorrhagic stroke, mortality was higher when surgery was performed within 4 weeks of the hemorrhagic event compared with later surgery (75% versus 40%, respectively).274”
From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [274]
The Surgery and Neurological Complications section reports 3 deaths among 4 patients operated on within 2 weeks (75%) and 2 among 5 operated on after 21 days (40%). Table 6 uses the same time groups; the study does not establish the claimed comparison of surgery within 4 weeks versus later surgery. (LLM, conf=0.90)
Experimental — accuracy not yet measuredSystemic embolization occurs in 22% to 50% of cases of infective endocarditis.
“Systemic embolization occurs in 22% to 50% of cases of IE. 55,57,[274][275][276][277]”
From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [274]
The Discussion reports 25% neurological complications and 19% vascular events in this cohort, not a rate of systemic embolization. A search for the 22%–50% range and for systemic embolization incidence found no passage in our copy that supports the claimed range. (LLM, conf=0.73)
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- Authors
- García-Cabrera, E., Fernández-Hidalgo, N., Almirante, B., Ivanova-Georgieva, R., Noureddine, M., Plata, A., Lomas, J. M., Gálvez-Acebal, J., Hidalgo-Tenorio, C., Ruíz-Morales, J., Martínez-Marcos, F. J., Reguera, J. M., de la Torre-Lima, J., & González, A. D. A.
- Affiliations
- Red Espanola de Investigacion en Patologia Infecciosa (ES)
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall...
- ORCID
- Venue
- Circulation
- Published
- 2013-06-11
- Volume
- 127
- Issue
- 23
- Pages
- 2272-2284
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC1700734
- OpenAlex
- W1964229213
- Semantic Scholar
- 0f677aa7ff948d305e924c9f32683395e294fad0
- Cited by
- 546
- References
- 50
- Citations by year
- 2026: 33 · 2025: 36 · 2024: 62 · 2023: 69 · 2022: 46 · 2021: 49 · 2020: 38 · 2019: 52 · 2018: 43 · 2017: 27 · 2016: 40 · 2015: 21 · 2014: 23 · 2013: 6 · 2012: 1
- FWCI
- 21.65
- Type
- journal article
- Language
- en
- Update notices
- correction (2013-07-23)
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Keywords
- infective endocarditis, neurological complications, ischemic stroke, cerebral hemorrhage, encephalopathy, meningitis, brain abscess, vegetation size, Staphylococcus aureus, mitral valve, anticoagulation, risk factors, mortality, timing of cardiac surgery, antimicrobial therapy
- MeSH terms
- Adult, Aged, Anti-Infective Agents, Anticoagulants, Brain Abscess, Intracranial Aneurysm, Cerebral Hemorrhage, Brain Ischemia, Combined Modality Therapy, Encephalitis, Endocarditis, Female, Follow-Up Studies, Humans, Male, Meningitis, Middle Aged, Postoperative Complications, Prognosis, Retrospective Studies, Risk Factors, Spain, Staphylococcal Infections, Ultrasonography, Multicenter Studies as Topic, Comorbidity, Incidence, Proportional Hazards Models, Treatment Outcome, Heart Valve Prosthesis Implantation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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