Clinical experience of infective endocarditis complicated by acute cerebrovascular accidents
Journal
Asian Journal of Surgery
Journal Volume
40
Journal Issue
2
Pages
100-105
Date Issued
2017
Author(s)
Abstract
Background/Objective To evaluate the clinical results of patients with infective endocarditis (IE) complicated by acute cerebrovascular accidents (CVAs). Methods A total of 44 patients with IE complicated by CVA at admission were retrospectively analyzed in a single medical institute from 2005 to 2011. At the time of admission, 18 patients were diagnosed with hemorrhagic stroke, and 26 patients were diagnosed with ischemic stroke. Fifteen patients received surgical intervention during hospitalization. Results The hospital mortality rate was 38.9% for the hemorrhagic stroke group and 42.3% for the ischemic stroke group (p?=?0.821). The mortality rate was 33.3% for the surgical group and 44.8% for the nonsurgical group (p?=?0.531). At 30 days of hospitalization, 45.8% of the patients experienced an adverse event (defined as death due to organ failure, restroke, cardiogenic shock, or septic shock during the treatment period), and the attrition rate was 1.5% per day. Surgery performed after the adverse events increased mortality (80.0%) compared with surgery performed on patients with no adverse events (10.0%; p?=?0.017). A Cox regression analysis revealed that creatinine > 2?mg/dL, diabetes, and staphylococcal infection were the risk factors of the adverse events. Conclusion Early surgical intervention for IE with ischemic stroke may prevent adverse events, particularly in patients with impaired renal function, diabetes, or staphylococcal infection. A delay in operation of > 30 days is recommended after hemorrhagic stroke. ? 2017
SDGs
Other Subjects
adult; aged; cerebrovascular accident; chi square distribution; cohort analysis; comparative study; complication; endocarditis; evaluation study; female; heart valve replacement; hospital mortality; hospitalization; human; Kaplan Meier method; male; middle aged; mortality; neurosurgery; nonparametric test; pathology; procedures; proportional hazards model; retrospective study; risk assessment; severity of illness index; statistics and numerical data; survival analysis; Taiwan; treatment outcome; Adult; Aged; Chi-Square Distribution; Cohort Studies; Endocarditis; Female; Heart Valve Prosthesis Implantation; Hospital Mortality; Hospitalization; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neurosurgical Procedures; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Stroke; Survival Analysis; Taiwan; Treatment Outcome
Publisher
Elsevier (Singapore) Pte Ltd
Type
journal article