Pre-operative stroke and neurological disability do not independently affect short- and long-term mortality in infective endocarditis patients.
BACKGROUND
Infective endocarditis (IE) is still associated with high morbidity and mortality. The impact of pre-operative stroke on mortality and long-term survival is controversial. In addition, data on the severity of neurological disability due to pre-operative stroke are scarce. We analysed the impact of pre-operative stroke and the severity of its related neurological disability on short- and long-term outcome.


METHODS
We retrospectively reviewed our data from patients operated for left-sided IE between 01/2007 and 04/2013. We performed univariate (Chi-Square and independent samples t test) and multivariate analyses.


RESULTS
Among 308 consecutive patients who underwent cardiac surgery for left-sided IE, pre-operative stroke was present in 87 (28.2 %) patients. Patients with pre-operative stroke had a higher pre-operative risk profile than patient without it: higher Charlson comorbidity index (8.1 ± 2.6 vs. 6.6 ± 3.3) and higher incidence of Staphylococcus aureus infection (43 vs. 17 %) and septic shock (37 vs. 19 %). In-hospital mortality was equal but 5-year survival was significantly worse with pre-operative stroke (33.1 % vs. 45 %, p = 0.006). 5-year survival was worst in patients with severe neurological disability compared to mild disability (19.0 vs. 0.58 %, p = 0.002). However, neither pre-operative stroke nor the degree of neurological disability appeared as an independent risk factor for short or long-term mortality by multivariate analysis.


CONCLUSIONS
Pre-operative stroke and the severity of neurological disability do not independently affect short- and long-term mortality in patients with infective endocarditis. It appears that patients with pre-operative stroke present with a generally higher risk profile. This information may substantially affect decision-making.
Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, Erlanger Allee 101, 07747, Jena, Germany.|Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt.
Mahmoud
M
Diab
Department of Neurology, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany.
Albrecht
A
Guenther
Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany.
Christoph
C
Sponholz
Center of Clinical Studies, Department of Cardiology, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany.
Thomas
T
Lehmann
Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, Erlanger Allee 101, 07747, Jena, Germany.
Gloria
G
Faerber
Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, Erlanger Allee 101, 07747, Jena, Germany.
Anna
A
Matz
Center for Infectious Diseases and Infection Control, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany.
Marcus
M
Franz
Department of Neurology, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany.
Otto W
OW
Witte
Center for Infectious Diseases and Infection Control, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany.
Mathias W
MW
Pletz
Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, Erlanger Allee 101, 07747, Jena, Germany. doenst@med.uni-jena.de.
Torsten
T
Doenst
D000368:Aged; D006348:Cardiac Surgical Procedures; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D004696:Endocarditis / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009460:Neurologic Examination; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
Cardiac surgery; Endocarditis; Stroke; Valve