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Neurological complications in infective endocarditis: risk factors and outcome.
Session:
Posters - F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Speaker:
Bárbara Marques Ferreira
Congress:
CPC 2021
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.2 Infective Endocarditis – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Bárbara Marques Ferreira; Ana Marques; Inês Cruz; Rita Pereira; Alexandra Briosa; João Grade Santos; Sofia Alegria; Daniel Sebaiti; Mariana Martinho; Ana Rita Almeida; Isabel João; Paula Fazendas; Hélder Pereira
Abstract
<p>Background: Neurological complications are frequent in patients (pts) with infective endocarditis (IE) and represent a major factor associated with an increased morbidity and mortality rate in that disease.</p> <p>Objective: The purpose of this study was to evaluate the incidence of neurological complications in pts with IE, determine the risk factors for their development and their influence on the clinical outcome. </p> <p>Methods and Results: Single-center retrospective analysis of pts with IE admitted during a 14 –year period (2006-2020). We identified 222 episodes of IE (213 pts), 36.0% with evidence of systemic embolization. The most frequent site was the central nervous system (CNS) (n=48; 21.6%). Patients with CNS embolization were predominantly male, with a mean age of 64±12 years; the aortic valve was the valve that was more frequently involved; the most common agents were Staphylococcus (31.3%) and Streptococcus (27.1%). Patients presented with ischemic stroke in 79.2% of cases (haemorrhagic transformation in 21.1%), haemorrhagic stroke in 10.4%, mycotic aneurism in 12.5%, and myelitis / meningitis in 2.1%. During follow-up (mean 750±1113 days), 31.3% were submitted to surgery (median time from admission to surgery 37 days; IQR 33-54); in-hospital mortality was 35.4% and 1-year mortality was 41.7%.</p> <p>Comparing with the global population, pts with CNS embolization were more likely to have diabetes (p=0.002), no involvement of the right valves (p=0.003) and pseudoaneurysm in transoesophageal echocardiography (p=0.024). In addition, they had longer hospitalizations (54 vs 44 days; p=0.007). There were no differences regarding mortality.</p> <p>Surgery was associated with reduced mortality, both in-hospital (p<0.001) and at 1 year (p<0.001). In multivariate Cox regression, cardiac surgery was a protective factor of 1-year mortality (HR 0.123; 95% CI 0.015-0.985, p=0.048); heart failure and septic shock were risk factors of 1-year mortality (HR 3.7; 95% CI 1.3-10.9; p=0.016, and HR 3.5; 95% CI 1.2-10.7; p=0.025, respectively).</p> <p>Conclusion: In our population the most common site of systemic embolization was the CNS, more often presented as ischemic stroke and the aortic valve was the valve that was more frequently involved. They had longer hospitalizations, but there were no differences in mortality. Surgery was a protective factor for in-hospital and 1-year mortality in pts with CNS embolization.</p>
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