Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, United States of America.
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, United States of America.
J Neurol Sci. 2022 Nov 15;442:120386. doi: 10.1016/j.jns.2022.120386. Epub 2022 Aug 23.
Neurological complications following infective endocarditis (IE) directly contribute to long-term morbidity. We examined the risk factors for different neurological complications of left-sided IE.
Using a database of consecutive adults admitted to a health system with left-sided IE from 2015 to 2019, the frequency of cerebral infarcts, intraparenchymal hemorrhage, cerebral microbleeds (CMB), mycotic aneurysm, and encephalopathy was determined. Variables with significant differences comparing each neurological complication (p < 0.1) were entered into regression models along with age to determine predictors.
211 patients with mean age 54 (±18) years, and 69 (33%) females were included. Infarcts were found in 118 (56%) patients, intraparenchymal hemorrhage was found in 17 (8%) patients, CMB were found in 58 (27%) patients, mycotic aneurysms were found in 22 (10%) patients, and encephalopathy occurred in 16 (8%) patients. In multivariable models, vegetation size ≥15 mm was associated with a higher risk of infarcts (aOR 2.26, 95% CI (1.12-4.57)), and the presence of a mycotic aneurysm was a risk factor for intraparenchymal hemorrhage (aOR 18.79, 95% CI (3.97-88.97)). Prosthetic valves (aOR 2.89, 95% CI (1.11-7.54)) and Staphylococcus aureus infection (aOR 3.50, 95% CI (1.08-11.36)) were associated with CMB. No risk factors emerged as predictors of encephalopathy.
Large vegetation size is associated with stroke in patients with IE. Mycotic aneurysms are found at a higher frequency in young patients and are the primary cause of intraparenchymal hemorrhage. CMB may be related to prosthetic valves and Staphylococcus aureus infection.
感染性心内膜炎（IE）后出现的神经系统并发症直接导致长期发病。我们研究了左侧 IE 不同神经系统并发症的危险因素。
使用 2015 年至 2019 年连续就诊于健康系统的左侧 IE 成人患者数据库，确定脑梗死、脑实质内出血、脑微出血（CMB）、真菌性动脉瘤和脑病的发生率。对每个神经系统并发症比较具有显著差异的变量（p<0.1）与年龄一起输入回归模型，以确定预测因素。
211 例患者平均年龄为 54（±18）岁，女性 69 例（33%）。118 例（56%）患者发现有梗死，17 例（8%）患者发现有脑实质内出血，58 例（27%）患者发现有 CMB，22 例（10%）患者发现有真菌性动脉瘤，16 例（8%）患者发现有脑病。多变量模型中，赘生物大小≥15mm 与梗死风险增加相关（优势比 2.26，95%可信区间（1.12-4.57）），真菌性动脉瘤的存在是脑实质内出血的危险因素（优势比 18.79，95%可信区间（3.97-88.97））。人工瓣膜（优势比 2.89，95%可信区间（1.11-7.54））和金黄色葡萄球菌感染（优势比 3.50，95%可信区间（1.08-11.36））与 CMB 相关。未发现与脑病相关的危险因素。
IE 患者大赘生物与卒中相关。年轻患者中真菌性动脉瘤的发生率较高，是脑实质内出血的主要原因。CMB 可能与人工瓣膜和金黄色葡萄球菌感染有关。
