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Predictors of Embolic Events in Infective Endocarditis – Reality in Portuguese Center
Session:
Sessão de Posters 44 - Endocardite Infecciosa
Speaker:
Nazar Ilchyshyn
Congress:
CPC 2024
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.8 Infective Endocarditis - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Nazar Ilchyshyn; Ana Catarina Gomes; Inês Cruz; Joana Varela de Sousa; João Grade Santos; Bárbara Ferreira; Mariana Martinho; Diogo Cunha; Oliveira Baltazar; Liliana Brochado; Hélder Pereira
Abstract
<p style="text-align:justify"><strong>Introduction:</strong> Infective endocarditis (IE) is associated with high mortality and morbidity. Embolic events (EE) are common complications of IE, being neurological complications associated with poor prognosis. Several clinical and echocardiographic factors, as well as risk scores such as Embolic Risk French Calculator (ER- alculator) and qSOFA have been studied as predictors of EE associated with IE, but no definite predictors have been established.</p> <p style="text-align:justify"><strong>Purpose: </strong>Our aim was to describe and compare the subgroups presenting with and without EE associated with IE, assess its clinical, echocardiographic, microbiological characteristics as well as to evaluate ER-Calculator and qSOFA scores as predictors of EE. </p> <p style="text-align:justify"><strong>Methods: </strong>Retrospective analysis of all patients admitted with IE between 2010 and 2022. Medical records were analyzed for clinical, echocardiographic and microbiological data. We compared both groups by Mann Whitney test based on non-normal distribution for continuous variables and Pearson's chi-squared test for categorical variables. Binary logistical regression was performed to assess EE predictors.</p> <p style="text-align:justify"><strong>Results: </strong>A total of 222 patients presented with IE, 84.2% with left heart IE. Most common microorganisms involved were Staphylococcus Aureus (SA) (n=61), followed by Streptococcus Viridans (n=26) and Streptococcus Bovis (n=19). Local complications were observed in 15.3%. EE were observed in 42.3%. </p> <p style="text-align:justify">EE was associated with younger age (median 65 years-old (IQR: 22), vs 70 years-old (IQR:20) (p= 0.003)), higher CPR value (8.59 mg/dL (IQR: 14.6) vs 6.55 (IQR: 9.8) (p= 0.010)), vegetation size above 10mm (53.4% vs 35.8% (p= 0.014)), higher 7- and 28-days ER-Calculator score (4% (IQR: 4) vs 3% (IQR; 4) (p= 0.009) and 6% (IQR:8) vs 5% (IQR:7) (p= 0.009), respectively). Statistical trend was observed towards increased risk of embolization in HIV and SA infections (15.1% vs 7.1% (p= 0.056) and 34.0% vs 22.7% (p= 0.060), respectively). EE was not associated with gender (77.7% vs 68.0% male (p= 0.112)), diabetes (24.5% vs 19.5% (p= 0.377)), atrial fibrillation (18.7% vs 26.0%, p= 0.206)), prosthetic valves (24.5% vs 25.0% (p= 0.928)) or qSOFA score (0-1 points 82.1% vs 88.8%, 2-3 points 17.9% vs 11.2% (p= 0.181)).</p> <p style="text-align:justify">Logistic regression model revealed >10mm vegetation size (OR= 1.758, p= 0.005) and SA infection (OR= 1.949, p= 0.043) as predictors of EE in IE, whereas ³75 years-old (OR= 0.458, p= 0.020) showed protective effect. Other EE associated factors did not show statistical significance in this model.</p> <p style="text-align:justify"><strong>Conclusions: </strong>Predictors of EE in IE were vegetation size and SA infection. Old age had protective effect. 7- and 28-days ER-Calculator risk were associated with EE, whereas qSOFA score were not.</p>
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