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

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2024-10-01 Epub Date: 2024-05-26 DOI:10.1177/17474930241255560
Sara Álvarez-Zaballos, Pilar Vázquez-Alen, Patricia Muñoz, Arístides de Alarcón, Encarnación Gutiérrez Carretero, Ana Álvarez-Uría, Mª Carmen Fariñas, Raquel Rodríguez-García, Miguel Ángel Goenaga, Guillermo Cuervo, Antonio Plata-Ciezar, Carmen Hidalgo-Tenorio, Gonzalo Aldamiz-Echevarría, Manuel Martínez-Sellés
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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.

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全国感染性心内膜炎队列中的中风患病率和预后影响。
背景:中风是感染性心内膜炎(IE)的常见并发症:中风是感染性心内膜炎(IE)的常见并发症。我们的目的是在全国前瞻性 IE 队列中描述中风的发病率和预后影响:方法:2008年至2021年期间连续纳入46家西班牙医院:结果:在5667例IE病例中,1125例患有急性中风(19.8%):811例缺血性中风(618例心肌栓塞性中风、193例心肌栓塞性中风伴出血性转变、4例短暂性脑缺血发作、3例腔隙性脑梗塞)、125例颅内出血和29例其他神经系统并发症(脑脓肿、脑炎、脑膜炎、癫痫发作)。与无中风的患者相比,中风患者的平均年龄(69 岁)相似,但女性患者较多(68.2% 对 63.7%,P=0.04),心内并发症(35% 对 30%,P=0.01)、手术指征(69.9% 对 65.9%,P=0.001)、院内死亡率(40.9% 对 22.0%,P=0.001)的发生率较高:五分之一的 IE 患者合并中风。中风与死亡率相关。
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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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