title: [Hepatosplenic and renal embolisms in infective endocarditis].
abstract: 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.
authors.affiliation: Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Luaces Méndez
authors.forename: Isidre
authors.initials: I
authors.lastname: Vilacosta
authors.forename: Cristina
authors.initials: C
authors.lastname: Sarriá
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández
authors.forename: José A
authors.initials: JA
authors.lastname: San Román
authors.forename: Juan V
authors.initials: JV
authors.lastname: Sanmartín
authors.forename: Javier
authors.initials: J
authors.lastname: López
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodríguez
mesh_terms: 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*