Neurological Complications of Infective Endocarditis

Autor:	Josefa Ruiz-Morales, José Manuel Lomas, Mariam Noureddine, Javier de la Torre-Lima, Francisco Javier Martínez-Marcos, Carmen Hidalgo-Tenorio, Antonio Plata, Radka Ivanova-Georgieva, Juan Gálvez-Acebal, Nuria Fernández-Hidalgo, J.M. Reguera, Benito Almirante, Arístides de Alarcón González, Emilio García-Cabrera
Přispěvatelé:	The Group for the Study of Cardiovascular Infections of the Andalusian Society of Infectious Diseases (SAEI) and the Spanish Network for Research in Infectious Diseases (REIPI), [García-Cabrera,E, Fernández-Hidalgo,N, Almirante,B, Ivanova-Georgieva,R, Noureddine,M, Plata,A, Lomas,ML, Gálvez-Acebal,J, Hidalgo-Tenorio,C, Ruíz-Morales,J, Martínez-Marcos,FJ, Reguera,JM, Torre-Lima,J De La, Alarcón González,A De] Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain. [García-Cabrera,E, Alarcón González,A De] Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain. [Ivanova-Georgieva,R] Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain. [Fernández-Hidalgo,N, Almirante,B] Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Medicine Department, Barcelona. [Ruíz-Morales,J] Infectious Diseases Service, Hospital Universitario Virgen de la Victoria, Malaga, Spain. [Noureddine,M] Infectious Diseases Unit Hospital Costa del Sol, Marbella, Malaga, Spain. [Plata,A, Ruíz-Morales,J] Infectious Diseases Service, Hospital Universitario Carlos Haya Malaga. [Lomas,JM, Martínez-Marcos,FJ] Infectious Diseases Unit Hospital Juan Ramón Jiménez, Huelva, Spain. [Gálvez-Acebal,J] Clinical Service of Infectious Disease and Clinical Microbiology, Hospital Universitario Virgen Macarena, Seville, Spain. [Hidalgo-Tenorio,C] Infectious Diseases Service, Hospital Universitario Virgen de las Nieves, Granada, Spain. [Alarcón González,A De] Infectious Diseases, Microbiology and Preventive Medicine Department, Hospital Universitario Virgen del Rocío, Seville, Spain., This study was funded by the Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III, and cofinanced by the European Development Regional Fund 'A way to achieve Europe', Spanish Network for the Research in Infectious Diseases (REIPI RD06/0008).
Rok vydání:	2013
Předmět:	Male Complications Analytical Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Models Statistical::Proportional Hazards Models [Medical Subject Headings] Diseases::Pathological Conditions Signs and Symptoms::Pathologic Processes::Postoperative Complications [Medical Subject Headings] Analytical Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Case-Control Studies::Retrospective Studies [Medical Subject Headings] Hemorragia cerebral Named Groups::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings] Comorbidity Analytical Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors [Medical Subject Headings] Brain Ischemia Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] Diseases::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Intracranial Arterial Diseases::Intracranial Aneurysm [Medical Subject Headings] Postoperative Complications Analytical Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Clinical Trials as Topic::Multicenter Studies as Topic [Medical Subject Headings] Anti-Infective Agents Risk Factors Health Care::Health Care Quality Access and Evaluation::Quality of Health Care::Epidemiologic Factors::Comorbidity [Medical Subject Headings] Diseases::Cardiovascular Diseases::Heart Diseases::Endocarditis [Medical Subject Headings] Infecciones estafilocócicas Diseases::Nervous System Diseases::Central Nervous System Diseases::Meningitis [Medical Subject Headings] Multicenter Studies as Topic Medicine Antiinfecciosos Absceso encefálico Ultrasonography Heart Valve Prosthesis Implantation Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Anticoagulants [Medical Subject Headings] Diseases::Virus Diseases::Central Nervous System Viral Diseases::Encephalitis [Medical Subject Headings] Endocarditis Incidence Incidence (epidemiology) Hazard ratio Pronóstico Middle Aged Staphylococcal Infections Comorbilidad Prognosis Combined Modality Therapy Cardiac surgery Diseases::Bacterial Infections and Mycoses::Brain Abscess [Medical Subject Headings] Treatment Outcome Infective endocarditis Cohort Encephalitis Female Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents [Medical Subject Headings] Estudios de seguimiento Aneurisma Intracraneal Infection Incidencia Cardiology and Cardiovascular Medicine Meningitis Factores de riesgo Nervous system Adult Analytical Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Combined Modality Therapy [Medical Subject Headings] medicine.medical_specialty Encephalopathy Check Tags::Male [Medical Subject Headings] Brain Abscess Estudios retrospectivos Analytical Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Morbidity::Incidence [Medical Subject Headings] Modelos de riesgos Proporcionales Physiology (medical) Internal medicine Analytical Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Follow-Up Studies [Medical Subject Headings] Named Groups::Persons::Age Groups::Adult [Medical Subject Headings] Humans Estudios multicéntricos como Asunto Named Groups::Persons::Age Groups::Adult::Aged [Medical Subject Headings] Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Positive Bacterial Infections::Staphylococcal Infections [Medical Subject Headings] Isquemia encefálica Analytical Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings] Aged Cerebral Hemorrhage Proportional Hazards Models Retrospective Studies Terapia combinada business.industry Proportional hazards model Diseases::Cardiovascular Diseases::Vascular Diseases::Cerebrovascular Disorders::Intracranial Hemorrhages::Cerebral Hemorrhage [Medical Subject Headings] Anticoagulants Encefalitis Intracranial Aneurysm Complicaciones postoperatorias medicine.disease Surgery Check Tags::Female [Medical Subject Headings] Spain Diseases::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Brain Ischemia [Medical Subject Headings] Analytical Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis [Medical Subject Headings] Resultado del tratamiento business Endocardium Follow-Up Studies
Zdroj:	Circulation. 127:2272-2284
ISSN:	1524-4539 0009-7322
DOI:	10.1161/circulationaha.112.000813
Popis:	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. Methods and 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 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.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e63f4cf3ffba94b5bcb9da09bf9a9708 https://doi.org/10.1161/circulationaha.112.000813 Zobrazit plný text záznamu