Risk factors for systemic emboli in infective endocarditis

Abstract

A retrospective study was undertaken to analyse the risk factors for systemic emboli in infective endocarditis. Patients (n = 80; 70% males; mean age 65 years; range 20-91 years) with infective endocarditis, as defined by the Duke criteria and diagnosed using transoesophageal echocardiography during the period January 1995 to March 2001, were included. The average time between the start of the illness and the beginning of antibiotic treatment was 55 days (range 0-405 days). The pathogens identified were streptococci (n = 47), staphylococci (n = 11), enterococci (n = 9), and others (n = 4). In nine cases, blood cultures were sterile. Thirty patients with at least one embolic episode were compared with 50 control patients. According to univariate analysis, the main risk factor for systemic emboli was the size of the vegetation (12.4 mm vs. 7.8 mm; p = 0.0005). The risk of emboli was 57% when the vegetation measured > 10 mm and only 22% when it was < 10 mm (p = 0.003). The mobility of the vegetation was also a risk factor: 48% if the vegetation was mobile; and 9% if fixed (p = 0.003). Sex, age, pathogen, antibiotic treatment, type of valve and the number and position of the vegetations were not found to be risk factors. With multivariate analysis, only mobility was identified as a risk factor. Overall, mobile vegetations > 10 mm in size were associated with an increased risk of embolic episodes in infective endocarditis.

Effect of Penicillin Resistance on Presentation and Outcome of Nonenterococcal Streptococcal Infective Endocarditis

“…Identifying subgroups of patients with infective endocarditis at higher risk for embolization is crucial to improve survival. Risk factors for embolization in infective endocarditis included staphylococcal infection, mitral valve disease, and vegetation size (≥10 mm) and its morphology [18,19,20,21]. In this current series, the overall incidence of all-site embolism in our patients of streptococcal endocarditis was 35%, which was not different from the results in previous studies [10, 22, 23].…”

“…Systemic embolization occurs in 22–68% of cases of infective endocarditis and more than 50% of embolic episodes involve the central nervous system [18,19,20,21]. Embolization has a great impact on prognosis.…”

Gangrene of the Left Forearm Following Septicaemia in a Nigerian Child With Tetralogy of Fallot: A Case Report

“…TOF carries a higher risk for IE due to associate multiple cardiac lesions, 4 and embolic events have been reported to occur in 22-44% of patients with IE, 9,10 although transthoraxic echocardiography did not reveal vegetations in this patient, a more sensitive trans oesophageal echocardiography which was not available in the centre) might have helped in confirming this diagnosis. 11,12 Another possible cause may be disseminated intravascular coagulopathies (DIC) complicating the septicemia. The possibility of DIC is suggested by thrombocytopenia observed in our centre compared after a normal platelet count at the referring centre.…”

Radiologic manifestations of extra-cardiac complications of infective endocarditis

“…Even with appropriate diagnosis and therapy, the mortality rate is 9-30% [1]. The overall incidence of native valve endocarditis is estimated to be 1.5-11.6 per 100,000 persons per year.…”

“…Valvular vegetations are a result of platelet and fibrin aggregation, bacterial adherence and proliferation, leading to thrombus formation [10]. The size and mobility of valvular vegetations are important predictors of whether or not the patient will develop septic emboli, the main causative factor for the extra-cardiac complications of IE [1]. Septic emboli can affect any organ or tissue in the body and occur in 12-40% of IE cases [11].…”