Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Neuroimaging. 2022 Sep;32(5):1001-1008. doi: 10.1111/jon.13020. Epub 2022 Jun 21.
Neurological complications from infective endocarditis (IE) are common and often present with minimal clinical symptoms. In this study, we examine whether screening neuroimaging in asymptomatic patients results in increased detection of neurological complications and leads to improved patient outcomes.
Using a database of consecutive adults with IE admitted to a single health system from 2015 to 2019, we selected patients who presented without any neurological symptoms and determined whether these patients underwent screening neuroimaging. The presence of septic emboli, territorial infarcts, intracranial hemorrhage, and mycotic aneurysms was recorded. Variables with significant differences in univariable analyses (p < .1) between those with and without screening neuroimaging were entered into regression models with age and sex to determine predictors of neurological complications and favorable discharge outcomes (modified Rankin score ≤2).
A total of 214 patients were included in the study, of which 154 (72%) received screening neuroimaging. Septic emboli were more common in patients who underwent screening imaging (31% vs. 15%, p = 0.02). In the first multivariate analysis, screening neuroimaging was associated with septic emboli (adjusted odds ratio [aOR] = 2.44, 95% confidence interval [CI]: [1.03-5.75], p = 0.04). In the second multivariate analysis, territorial infarcts (aOR = 0.28, 95% CI: [0.11-0.73], p = .01), but not septic emboli (aOR = 0.71, 95% CI: [0.36-1.43], p = 0.34), were associated with a favorable discharge outcome.
Screening neuroimaging leads to the detection of more septic emboli in IE, but only territorial infarcts (in contrast to septic emboli) correlate with an unfavorable discharge outcome.
感染性心内膜炎（IE）引起的神经系统并发症很常见，且通常表现为轻微的临床症状。本研究旨在探讨对无症状患者进行神经影像学筛查是否能提高神经系统并发症的检出率，并改善患者的预后。
我们使用了一个连续的成人 IE 患者数据库，这些患者于 2015 年至 2019 年期间在一个单一的医疗系统就诊。我们选择了那些没有任何神经系统症状的患者，并确定这些患者是否接受了神经影像学筛查。记录了脓毒性栓子、区域性梗死、颅内出血和真菌性动脉瘤的存在。对单变量分析中差异有统计学意义的变量（p<0.1），采用年龄和性别回归模型，分析神经并发症和有利出院结局（改良 Rankin 评分≤2）的预测因素。
共有 214 例患者纳入研究，其中 154 例（72%）接受了神经影像学筛查。接受筛查的患者中，脓毒性栓子更为常见（31% vs. 15%，p=0.02）。在第一个多变量分析中，神经影像学筛查与脓毒性栓子有关（调整后的优势比[aOR] 2.44，95%置信区间[CI]：[1.03-5.75]，p=0.04）。在第二个多变量分析中，区域性梗死（aOR 0.28，95% CI：[0.11-0.73]，p=0.01），而非脓毒性栓子（aOR 0.71，95% CI：[0.36-1.43]，p=0.34），与有利的出院结局相关。
神经影像学筛查可提高 IE 患者脓毒性栓子的检出率，但只有区域性梗死（与脓毒性栓子相反）与不良出院结局相关。
