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Neurological Complications of Infective Endocarditis: Risk Factors, Outcome, and Impact of Cardiac Surgery: A Multicenter Observational Study
Open accessAbstract
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%, 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]
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“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]
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2015 ESC Guidelines for the management of infective endocarditis
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Metadata
- 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
- 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 › Cardiology and Cardiovascular Medicine › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Infectious Diseases › 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
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