Long-term Outcome of Neurological Complications after Infective Endocarditis

Abstract

Severe neurological complications following infective endocarditis remain a major problem with high mortality rate. the long-term neurological consequences following infective endocarditis remain uncertain. otherwise, neurosurgeries could be performed after these complications; however, few clinical series have reported the results. therefore, we utilized a large, nationwide database to unveil the long-term mortality and neurosurgical outcome following infective endocarditis. We included patients with a first-time discharge diagnosis of infective endocarditis between January 2001 and December 2013 during hospitalization. Patients were further divided into subgroups consisting of neurological complications under neurosurgical treatment and complications under non-neurosurgical treatment. Long-term result of symptomatic neurological complications after infective endocarditis and all-cause mortality after different kinds of neurosurgeries were analyzed. There were 16,495 patients with infective endocarditis included in this study. Symptomatic neurological complications occurred in 1,035 (6.27%) patients, of which 279 (26.96%) accepted neurosurgical procedures. Annual incidence of neurological complications gradually increased from 3.6% to 7.4% (P < 0.001). The mortality rate among these patients was higher than that among patients without complications (48.5% vs. 46.1%, P = 0.012, increased from 20% initially to nearly 50% over the 5-year follow-up). However, neurosurgery had no effect on the long-term mortality rate (50.9% vs. 47.6%, P = 0.451). Incidence of neurological complications post-infective endocarditis is increasing, and patients with these complications have higher mortality rates than patients without. neurosurgery in these populations was not associated with higher long-term mortality. therefore, it should not be ruled out as an option for those with neurological complications. Neurological complications following infective endocarditis (IE) remain a major clinical problem with a poor prognosis 1-3. Despite many changes in the epidemiology, diagnosis, and management of IE, the incidence of and morbidity associated with neurological complications have remained unchanged or even increased in recent years 4-6. Neurological complications during an active course of IE have been reported to occur in 20-40% of patients 1-3,7,8 and were associated with high mortality rates (22-58%) 1-3,9,10. Neurological complications may refer to a broad spectrum of conditions ranging from nonspecific manifestations, such as encephalopathy, seizures or headaches, to fatal aneurysm rupture and cerebral hemorrhage 1-3. In fact, nonspecific or transient symptoms show no obvious impact and relatively good outcomes 1. However, the long-term outcome of symptomatic cerebral involvement within IE is still uncertain.

Anesthesia Considerations in Infective Endocarditis

“…155 Neurosurgical intervention after cardiac surgery, e.g., after new-onset intracranial hemorrhage, is accompanied by significant mortality. However, recent data suggest that neurosurgery per se does not seem to further increase mortality in this setting, 156 and again, a multidisciplinary case-by-case decision is to be made.…”

Acute Ischaemic Stroke in Infective Endocarditis: Pathophysiology and Clinical Outcomes in Patients Treated with Reperfusion Therapy

“…The incidence of neurological complications, such as AIS, secondary to IE has been increasing gradually [3]. Whilst speculative, this may be due to an increasing number of invasive procedures leading to transient bacteraemia and gradual increases in high-risk populations, such as the elderly, diabetics and patients on haemodialysis or with prosthetic cardiac valves [3].…”

“…The incidence of neurological complications, such as AIS, secondary to IE has been increasing gradually [3]. Whilst speculative, this may be due to an increasing number of invasive procedures leading to transient bacteraemia and gradual increases in high-risk populations, such as the elderly, diabetics and patients on haemodialysis or with prosthetic cardiac valves [3]. However, initiation of antibiotics is a preventative method for CVC secondary to IE with one study reporting 25% of IE patients not receiving antibiotics experienced CVC compared to 6% of those receiving antibiotic therapy [38].…”

“…Patients with IE may present with a neurovascular emergency such as AIS, haemorrhage or mycotic aneurysm [2]. Previous studies have reported mortality rates as high as 55-58% in IE secondary to stroke [3,4]. IE is increasingly involving elderly patients: more than one-third of patients in Western nations are now beyond the age of 70 [5], with lower surgical treatment rates and a high mortality rate being the noticeable characteristics [6].…”

“…Moreover, reperfusion therapies are often less efficacious in these patients [7]. The data on risk factors and prognostic determinants of short-term and long-term clinical outcomes in patients with IE, especially those with comorbid stroke, is very limited [3,8,9]. This article aims to provide an overview of the pathophysiology and epidemiology of IE and stroke and outcomes in AIS patients with a background in IE.…”