title: Neurological complications of infective endocarditis: risk factors, outcome, and impact of cardiac surgery: a multicenter observational study.
abstract: 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.
  
  
  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.
authors: Spanish Network for Research in Infectious Diseases, Seville, Spain.
authors: Emilio
authors: E
authors: García-Cabrera
authors: Nuria
authors: N
authors: Fernández-Hidalgo
authors: Benito
authors: B
authors: Almirante
authors: Radka
authors: R
authors: Ivanova-Georgieva
authors: Mariam
authors: M
authors: Noureddine
authors: Antonio
authors: A
authors: Plata
authors: Jose M
authors: JM
authors: Lomas
authors: Juan
authors: J
authors: Gálvez-Acebal
authors: Carmen
authors: C
authors: Hidalgo-Tenorio
authors: Josefa
authors: J
authors: Ruíz-Morales
authors: Francisco J
authors: FJ
authors: Martínez-Marcos
authors: Jose M
authors: JM
authors: Reguera
authors: Javier
authors: J
authors: de la Torre-Lima
authors: Arístides
authors: A
authors: de Alarcón González
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001922:Brain Abscess / Q000453:epidemiology / Q000209:etiology*; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology*; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D003131:Combined Modality Therapy; D015897:Comorbidity; D004660:Encephalitis / Q000453:epidemiology / Q000209:etiology*; D004696:Endocarditis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008581:Meningitis / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000150:complications / Q000453:epidemiology; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000890:Anti-Infective Agents; D000925:Anticoagulants
keywords: complications; endocardium; infection; nervous system