title: [Risk factors and prognosis of neurological complications in patients with infective endocarditis].
abstract: OBJECTIVE
  To identify risk factors of neurological complications (NC) in left-sided infective endocarditis (IE) and to assess its impact on the outcome and cardiac surgery.
  
  
  METHODS
  Clinical data, NC, treatment and outcome of patients with definite left-sided IE admitted to our hospital during 2001-2012 were retrospectively analyzed.
  
  
  RESULTS
  A total of 308 patients with age of (45.3±15.9) years were enrolled. Among them, 65 (21.1%) experienced at least one NC. Independent risk factors associated with NC were large vegetation (HR=1.681, 95%CI 1.013-2.788, P=0.044), non-neurologic embolism (HR=1.820, 95%CI 1.068-3.100, P=0.028), mitral valve involvement (HR=1.888, 95%CI 1.089-3.274, P=0.024), Staphylococcus aureus infection (HR=2.054, 95%CI 1.097-3.846, P=0.044), and uncontrolled infection (HR=4.680, 95%CI 2.563-8.546, P<0.001). During a median follow-up for 17 months, 70 (22.7%) patients died. NC had a negative impact on long-term outcome (HR=2.292, 95%CI 1.274-4.122, P=0.006). Valve replacement surgery was performed in 156(50.6%)patients, which was associated with a lower rate of 1-year IE-related death (HR=0.160, 95%CI 0.063-0.405, P<0.001). Among patients with NC, valve replacement surgery was associated with lower rates of in-hospital mortality and 1-year IE-related mortality (14.8% vs 5.3%, 18.5% vs 73.7%, respectively, P<0.001).
  
  
  CONCLUSIONS
  Independent risk factors of NC include large vegetation, non-neurologic embolism, mitral valve involvement, Staphylococcus aureus infection, and uncontrolled infection. Neurologic complications link to the poor prognosis in patients with left-sided IE. Valve surgery is considered as a safe procedure and improves the survival.
authors.forename: H
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: L L
authors.initials: LL
authors.lastname: Guo
authors.forename: L G
authors.initials: LG
authors.lastname: Fang
authors.forename: L Y
authors.initials: LY
authors.lastname: Cui
authors.forename: Q
authors.initials: Q
authors.lastname: Miao
authors.forename: T S
authors.initials: TS
authors.lastname: Li
authors.forename: W L
authors.initials: WL
authors.lastname: Zhu
authors.forename: Q
authors.initials: Q
authors.lastname: Fang
mesh_terms: D000328:Adult; D000368:Aged; D004696:Endocarditis; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D013211:Staphylococcus aureus; D016896:Treatment Outcome