[Hepatosplenic and renal embolisms in infective endocarditis].
OBJECTIVE
Among the complications of infective endocarditis, systemic embolisms are an ominous prognostic sign. The aim of the present study was to compare the demographic, clinical, microbiologic and echocardiographic features of episodes of endocarditis accompanied and unaccompanied by embolisms in the spleen, kidney or liver. We also assessed the prognostic impact of these embolisms.


METHODS
Prospective, multicenter clinical cohort study. We analyzed 338 consecutive episodes of left-sided infective endocarditis in 308 patients. Episodes were classified in two groups: group I, episodes with hepatosplenic or renal embolisms (n=34); group II, episodes without embolisms (n=304).


RESULTS
There were 41 embolisms in 34 episodes (10%). Of these, 34 were located in the spleen, 5 in the kidney and 2 in the liver. Some forms of clinical presentation predominated in group I, e.g., abdominal pain, splenomegaly, cutaneous stigmata, hematuria, embolisms in other locations, and septic shock. Staphylococcus aureus and enterococci were more commonly isolated in group I. Detection of vegetations (by transesophageal echocardiography) was more frequent in group I, and they were larger than vegetations in group II. Hepatosplenic and renal embolisms were not independently associated with the need for cardiac surgery or death.


CONCLUSIONS
Hepatosplenic and renal embolisms occur in 10% of left-sided episodes of infective endocarditis. The clinical presentation of these episodes has characteristic features. Vegetations are larger than in episodes without these embolism. Hepatosplenic and renal embolisms do not increase neither the need of cardiac surgery nor the risk of death.
Luaces Méndez
María
M
Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain.
Vilacosta
Isidre
I
Sarriá
Cristina
C
Fernández
Cristina
C
San Román
José A
JA
Sanmartín
Juan V
JV
López
Javier
J
Rodríguez
Enrique
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004617:Embolism / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004697:Endocarditis, Bacterial / Q000150:complications*; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply*; D008099:Liver / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013154:Spleen / Q000098:blood supply*