Prevalence and prognostic impact of stroke in a national cohort of infective endocarditis

Background: Stroke is a common complication of infective endocarditis (IE). Our aim was to describe the prevalence and prognostic impact of stroke in a national cohort of IE. Methods: Consecutive inclusion at 46 Spanish hospitals between 2008 and 2021. Results: Out of 5667 IE cases, 1125 had acute s...

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Detalles Bibliográficos
Autores: Álvarez Zaballos, Sara, Vázquez Alen, Pilar, Muñoz, Patricia, Alarcón González, Arístides de, Gutiérrez Carretero, Encarnación, Álvarez Uría, Ana, Fariñas Álvarez, María del Carmen, Rodríguez García, Raquel, Goenaga, Miguel Ángel, Cuervo, Guillermo, Plata Ciezar, Antonio, Hidalgo Tenorio, Carmen, Aldamiz Echevarría, Gonzalo, Martínez Sellés, Manuel
Tipo de recurso: artículo
Fecha de publicación:2024
País:España
Institución:Universidad de Cantabria (UC)
Repositorio:UCrea Repositorio Abierto de la Universidad de Cantabria
Idioma:inglés
OAI Identifier:oai:repositorio.unican.es:10902/35700
Acceso en línea:https://hdl.handle.net/10902/35700
Access Level:acceso abierto
Palabra clave:Infective endocarditis
Emboli
Mortality
Prognosis
Stroke
Descripción
Sumario:Background: Stroke is a common complication of infective endocarditis (IE). Our aim was to describe the prevalence and prognostic impact of stroke in a national cohort of IE. Methods: Consecutive inclusion at 46 Spanish hospitals between 2008 and 2021. Results: Out of 5667 IE cases, 1125 had acute stroke (19.8%): 818 ischemic strokes (811 cardioembolic strokes (193 with hemorrhagic transformation), 4 transient ischemic attacks, 3 lacunar infarctions), 127 intracranial hemorrhages, and 27 other neurological complications (cerebral abscesses, encephalitis, and meningitis). Compared to patients without stroke, those with stroke had a similar mean age (69 years) but were more frequently female (68.2% vs 63.7%, p = 0.04) and had a higher incidence of intracardiac complications (35% vs 30%, p = 0.01), surgical indication (69.9% vs 65.9%, p = 0.001), in-hospital mortality (40.9% vs 22.0%, p < 0.001), and 1-year mortality (46.2% vs 27.9%, p < 0.001). The following variables were independently associated with stroke: mitral location (odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.34-1.8, p < 0.001), vascular phenomenon (OR = 2.9, 95% CI = 2.4-3.6, p = 0.0001), acute renal failure (OR = 1.2, 95% CI = 1.0-1.4, p = 0.021), septic shock (OR = 1.3, 95% CI = 1.1-1.6, p = 0.007), sepsis (OR = 1.3, 95% CI = 1.1-1.6, p = 0.005), surgery indicated but not performed (OR = 1.4, 95% CI = 1.2-1.7, p < 0.001), community-acquired IE (OR = 1.2, 95% CI = 1-1.4, p = 0.017), and peripheral embolization (OR = 1.6, 95% CI = 1.4-1.9, p < 0.001). Stroke was an independent predictor of in-hospital (OR = 2.1, 95% CI = 1.78-2.51, p < 0.001) and 1-year mortality (hazard ratio = 1.9, 95% CI = 1.6-2.5). Conclusion: One-fifth of patients with IE have concomitant stroke. Stroke is associated with mortality.

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