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

Abstract: 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.

 Fuente: International Journal of Stroke, 2024, 19(9), 989-998

 Publisher: SAGE Publications

 Year of publication: 2024

 No. of pages: 10

 Publication type: Article

 DOI: 10.1177/17474930241255560

 ISSN: 1747-4930

 Publication Url: https://doi.org/10.1177/17474930241255560

Authorship

ÁLVAREZ ZABALLOS, SARA

VÁZQUEZ ALEN, PILAR

MUÑOZ, PATRICIA

ALARCÓN, ARÍSTIDES DE

GUTIÉRREZ CARRETERO, ENCARNACIÓN

ÁLVAREZ URÍA, ANA

RODRÍGUEZ GARCÍA, RAQUEL

GOENAGA, MIGUEL ÁNGEL

CUERVO, GUILLERMO

PLATA CIEZAR, ANTONIO

HIDALGO TENORIO, CARMEN

ALDAMIZ ECHEVARRÍA, GONZALO

MARTÍNEZ SELLÉS, MANUEL