Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan.
Department of Cardiology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan.
Sci Rep. 2020 Mar 4;10(1):3994. doi: 10.1038/s41598-020-60995-3.
Severe neurological complications following infective endocarditis remain a major problem with high mortality rate. The long-term neurological consequences following infective endocarditis remain uncertain. Otherwise, neurosurgeries could be performed after these complications; however, few clinical series have reported the results. Therefore, we utilized a large, nationwide database to unveil the long-term mortality and neurosurgical outcome following infective endocarditis. We included patients with a first-time discharge diagnosis of infective endocarditis between January 2001 and December 2013 during hospitalization. Patients were further divided into subgroups consisting of neurological complications under neurosurgical treatment and complications under non-neurosurgical treatment. Long-term result of symptomatic neurological complications after infective endocarditis and all-cause mortality after different kinds of neurosurgeries were analyzed. There were 16,495 patients with infective endocarditis included in this study. Symptomatic neurological complications occurred in 1,035 (6.27%) patients, of which 279 (26.96%) accepted neurosurgical procedures. Annual incidence of neurological complications gradually increased from 3.6% to 7.4% (P < 0.001). The mortality rate among these patients was higher than that among patients without complications (48.5% vs. 46.1%, P = 0.012, increased from 20% initially to nearly 50% over the 5-year follow-up). However, neurosurgery had no effect on the long-term mortality rate (50.9% vs. 47.6%, P = 0.451). Incidence of neurological complications post-infective endocarditis is increasing, and patients with these complications have higher mortality rates than patients without. Neurosurgery in these populations was not associated with higher long-term mortality. Therefore, it should not be ruled out as an option for those with neurological complications.
感染性心内膜炎（IE）后严重的神经系统并发症仍然是一个具有高死亡率的主要问题。IE 后长期的神经系统后果仍不确定。否则，这些并发症发生后可以进行神经外科手术；然而，很少有临床系列报道其结果。因此，我们利用一个大型的全国性数据库揭示 IE 后感染性心内膜炎的长期死亡率和神经外科治疗结果。我们纳入了 2001 年 1 月至 2013 年 12 月期间住院期间首次确诊为感染性心内膜炎的患者。患者进一步分为接受神经外科治疗的神经系统并发症亚组和非神经外科治疗的并发症亚组。分析 IE 后有症状的神经系统并发症的长期结果和不同类型神经外科手术后的全因死亡率。本研究共纳入 16495 例感染性心内膜炎患者。有症状的神经系统并发症发生在 1035 例（6.27%）患者中，其中 279 例（26.96%）接受了神经外科手术。神经系统并发症的年发生率从 3.6%逐渐增加到 7.4%（P < 0.001）。这些患者的死亡率高于无并发症患者（48.5% vs. 46.1%，P = 0.012，5 年随访期间死亡率从最初的 20%增加到近 50%）。然而，神经外科手术对长期死亡率没有影响（50.9% vs. 47.6%，P = 0.451）。IE 后神经系统并发症的发生率正在增加，有这些并发症的患者死亡率高于无并发症患者。这些人群中的神经外科手术与较高的长期死亡率无关。因此，对于有神经系统并发症的患者，不应排除神经外科手术的可能性。
