Sanguettoli Federico, Marchini Federico, Frascaro Federica, Zanarelli Luca, Campo Gianluca, Sinning Christoph, Tan Timothy C, Pavasini Rita
UO Cardiologia, Azienda Ospedaliero Universitaria di Ferrara, 44124 Ferrara, Italy.
Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany.
J Clin Med. 2024 Nov 22;13(23):7053. doi: 10.3390/jcm13237053.
Infective endocarditis (IE) is associated with significant neurological complications (NCs). The impact of neurological sequelae due to IE, however, is not well characterized. Thus, the aim of this systematic review and meta-analysis is to determine whether patients who experienced NCs from IE had worse outcomes compared to those without neurological complications. We conducted a systematic and comprehensive literature search of MEDLINE, Cochrane Library, Google Scholar, and BioMed Central (PROSPERO registration ID: CRD42024518651). Data on the primary outcome of all-cause mortality and the secondary outcome of surgical timing were extracted from 25 observational studies on patients with confirmed IE, both with and without NC. In the pooled total of patients with IE, NCs were present in 23.7% (60.8% ischaemic stroke and 16.4% haemorrhagic stroke). All-cause mortality was significantly higher in patients with IE and NCs (OR 1.78, CI 1.47-2.17, < 0.0001) compared to those without, particularly in those with major neurological events (OR 2.18, CI 1.53-3.10, < 0.0001). Conversely, minor or asymptomatic strokes showed no significant correlation with mortality (OR 1.10, CI 0.82-1.47, = 0.543). There was no significant difference in the timing of surgical intervention (standardized mean difference -0.53, CI -1.67 to 0.61, = 0.359) between the two patient groups. Major NCs due to infective endocarditis were associated with a significantly increased all-cause mortality. This underscores the critical importance of early recognition and management strategies tailored to the severity of neurological events.
感染性心内膜炎（IE）与严重的神经系统并发症（NCs）相关。然而，IE所致神经后遗症的影响尚未得到充分描述。因此，本系统评价和荟萃分析的目的是确定与无神经系统并发症的患者相比，经历IE相关NCs的患者预后是否更差。我们对MEDLINE、Cochrane图书馆、谷歌学术和生物医学中心进行了系统全面的文献检索（PROSPERO注册号：CRD42024518651）。从25项关于确诊IE患者（有或无NCs）的观察性研究中提取了全因死亡率这一主要结局以及手术时机这一次要结局的数据。在IE患者的汇总总数中，NCs的发生率为23.7%（缺血性卒中占60.8%，出血性卒中占16.4%）。与无NCs的患者相比，IE合并NCs的患者全因死亡率显著更高（OR 1.78，CI 1.47 - 2.17，<0.0001），尤其是那些发生重大神经事件的患者（OR 2.18，CI 1.53 - 3.10，<0.0001）。相反，轻微或无症状性卒中与死亡率无显著相关性（OR 1.10, CI 0.82 - 1.47, = 0.543）。两组患者在手术干预时机方面无显著差异（标准化均数差 -0.53，CI -1.67至0.61，= 0.359）。感染性心内膜炎所致的重大NCs与全因死亡率显著增加相关。这凸显了根据神经事件的严重程度进行早期识别和制定管理策略的至关重要性。
