title: Clinical experience of infective endocarditis complicated by acute cerebrovascular accidents.
abstract: OBJECTIVE
  To evaluate the clinical results of patients with infective endocarditis (IE) complicated by acute cerebrovascular accidents (CVAs).
  
  
  METHODS
  A total of 44 patients with IE complicated by CVA at admission were retrospectively analyzed in a single medical institute from 2005 to 2011. At the time of admission, 18 patients were diagnosed with hemorrhagic stroke, and 26 patients were diagnosed with ischemic stroke. Fifteen patients received surgical intervention during hospitalization.
  
  
  RESULTS
  The hospital mortality rate was 38.9% for the hemorrhagic stroke group and 42.3% for the ischemic stroke group (p = 0.821). The mortality rate was 33.3% for the surgical group and 44.8% for the nonsurgical group (p = 0.531). At 30 days of hospitalization, 45.8% of the patients experienced an adverse event (defined as death due to organ failure, restroke, cardiogenic shock, or septic shock during the treatment period), and the attrition rate was 1.5% per day. Surgery performed after the adverse events increased mortality (80.0%) compared with surgery performed on patients with no adverse events (10.0%; p = 0.017). A Cox regression analysis revealed that creatinine > 2 mg/dL, diabetes, and staphylococcal infection were the risk factors of the adverse events.
  
  
  CONCLUSIONS
  Early surgical intervention for IE with ischemic stroke may prevent adverse events, particularly in patients with impaired renal function, diabetes, or staphylococcal infection. A delay in operation of > 30 days is recommended after hemorrhagic stroke.
authors.affiliation: Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Chan-Yang
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Nai-Hsin
authors.initials: NH
authors.lastname: Chi
authors.affiliation: Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Shoei-Shen
authors.initials: SS
authors.lastname: Wang
authors.affiliation: Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Yih-Sharng
authors.initials: YS
authors.lastname: Chen
authors.affiliation: Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: hsiyuyu@gmail.com.
authors.forename: Hsi-Yu
authors.initials: HY
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004696:Endocarditis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020521:Stroke / Q000209:etiology* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome
keywords: infective endocarditis; stroke; valve replacement