Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Kirstein 473, Boston, MA 02215, USA.
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, USA.
J Stroke Cerebrovasc Dis. 2022 Aug;31(8):106626. doi: 10.1016/j.jstrokecerebrovasdis.2022.106626. Epub 2022 Jul 4.
The aim of this study is to explore the clinical features associated with neurological complications of infective endocarditis (IE) and to assess the impact of neurological complications on clinical outcomes.
The frequency of relevant clinical features was compared in a case series of IE patients with and without neurological complications admitted to a single health care system from 2015 to 2019. Variables with significant differences (p ≤ 0.05) in baseline characteristics in univariate logistic regression models were entered into multivariable models along with age to determine associations with neurological complications, unfavorable discharge outcomes (modified Rankin score ≥ 3), and in-hospital mortality.
260 patients with a mean age of 51 (±18) years and 103 (40%) females were included. Neurological complications occurred in 165 (63%) patients, with the most common being septic emboli (66 patients, 25%). In the regression analyses, antiplatelet usage (aOR 1.87, 95% CI [1.05-3.32]) and mitral valve vegetations (aOR 2.66, 95% CI [1.22-5.79]) were independently associated with neurological complications. Territorial infarction (aOR 4.13, 95% CI [1.89-9.06]) and encephalopathy (aOR 3.95, 95% CI [1.19-13.05]) were associated with an increased risk of unfavorable outcome, while cardiac surgery was associated with a lower risk of both unfavorable outcome (aOR 0.40, 95% CI [0.22-0.71]) and in-hospital mortality (aOR 0.18, 95% CI [0.09-0.35]).
Neurological complications are common in IE patients and are associated with mitral valve endocarditis and antiplatelet usage. Of the neurological complications, territorial infarcts and encephalopathy are associated with unfavorable discharge outcomes.
本研究旨在探讨感染性心内膜炎（IE）并发神经系统并发症的临床特征，并评估神经系统并发症对临床结局的影响。
我们对 2015 年至 2019 年期间在单一医疗系统住院的 IE 患者进行了病例系列研究，比较了有和无神经系统并发症患者的相关临床特征频率。在单变量逻辑回归模型中，具有显著差异（p≤0.05）的变量与年龄一起纳入多变量模型，以确定与神经系统并发症、不良出院结局（改良 Rankin 评分≥3）和住院死亡率相关的因素。
共纳入 260 例患者，平均年龄为 51（±18）岁，103 例（40%）为女性。165 例（63%）患者发生神经系统并发症，最常见的是感染性栓子（66 例，25%）。在回归分析中，抗血小板治疗（比值比 [OR] 1.87，95%置信区间 [CI] [1.05-3.32]）和二尖瓣赘生物（OR 2.66，95% CI [1.22-5.79]）与神经系统并发症独立相关。区域性梗死（OR 4.13，95% CI [1.89-9.06]）和脑病（OR 3.95，95% CI [1.19-13.05]）与不良结局风险增加相关，而心脏手术与不良结局（OR 0.40，95% CI [0.22-0.71]）和住院死亡率（OR 0.18，95% CI [0.09-0.35]）风险降低相关。
神经系统并发症在 IE 患者中很常见，与二尖瓣心内膜炎和抗血小板治疗相关。在神经系统并发症中，区域性梗死和脑病与不良出院结局相关。
