Cerebrovascular complications and outcomes of critically ill adult patients with infective endocarditis.
Endocarditis
Neuro-critical care
Stroke
Thoracic surgery
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
30 Dec 2022
30 Dec 2022
Historique:
received:
25
08
2022
accepted:
24
11
2022
entrez:
30
12
2022
pubmed:
31
12
2022
medline:
31
12
2022
Statut:
epublish
Résumé
Neurological complications are associated with poor outcome in patients with infective endocarditis (IE). Although guidelines recommend systematic brain imaging in the evaluation of IE patients, the association between early brain imaging findings and outcomes has never been evaluated in critically ill patients. We aimed to assess the association of CT-defined neurological complications with functional outcomes of critically ill IE patients. This retrospective cohort study included consecutive patients with severe, left-sided IE hospitalized in the medical ICU of a tertiary care hospital. Patients with no baseline brain CT were excluded. Baseline CT-scans were classified in five mutually exclusive categories (normal, moderate-to-severe ischemic stroke, minor ischemic stroke, intracranial hemorrhage, other abnormal CT). The primary endpoint was 1-year favorable outcome, defined by a modified Rankin Scale score of 0-3. Between 06/01/2011 and 07/31/2018, 156 patients were included. Among them, 87/156 (56%) had a CT-defined neurological complication, including moderate-to-severe ischemic stroke (n = 33/156, 21%), intracranial hemorrhage (n = 24/156, 15%), minor ischemic stroke (n = 29/156, 19%), other (n = 3/156, 2%). At one year, 69 (45%) patients had a favorable outcome. Factors negatively associated with favorable outcome in multivariable analysis were moderate-to-severe ischemic stroke (OR 0.37, 95%CI 0.14 - 0.95) and age (OR 0.94, 95%CI 0.91-0.97). By contrast, the score on the Glasgow Coma Scale was positively associated with favorable outcome (per 1-point increment, OR 1.23, 95%CI 1.08-1.42). Sensitivity analyses conducted in operated patients revealed similar findings. Compared to normal CT, only moderate-to-severe ischemic stroke was associated with more frequent post-operative neurological complications (n = 8/23 (35%) vs n = 1/46 (2%), p < 0.01). Moderate-to-severe ischemic stroke had an independent negative impact on 1-year functional outcome in critically ill IE patients; whereas other complications, including intracranial hemorrhage, had no such impact.
Sections du résumé
BACKGROUND
BACKGROUND
Neurological complications are associated with poor outcome in patients with infective endocarditis (IE). Although guidelines recommend systematic brain imaging in the evaluation of IE patients, the association between early brain imaging findings and outcomes has never been evaluated in critically ill patients. We aimed to assess the association of CT-defined neurological complications with functional outcomes of critically ill IE patients.
METHODS
METHODS
This retrospective cohort study included consecutive patients with severe, left-sided IE hospitalized in the medical ICU of a tertiary care hospital. Patients with no baseline brain CT were excluded. Baseline CT-scans were classified in five mutually exclusive categories (normal, moderate-to-severe ischemic stroke, minor ischemic stroke, intracranial hemorrhage, other abnormal CT). The primary endpoint was 1-year favorable outcome, defined by a modified Rankin Scale score of 0-3.
RESULTS
RESULTS
Between 06/01/2011 and 07/31/2018, 156 patients were included. Among them, 87/156 (56%) had a CT-defined neurological complication, including moderate-to-severe ischemic stroke (n = 33/156, 21%), intracranial hemorrhage (n = 24/156, 15%), minor ischemic stroke (n = 29/156, 19%), other (n = 3/156, 2%). At one year, 69 (45%) patients had a favorable outcome. Factors negatively associated with favorable outcome in multivariable analysis were moderate-to-severe ischemic stroke (OR 0.37, 95%CI 0.14 - 0.95) and age (OR 0.94, 95%CI 0.91-0.97). By contrast, the score on the Glasgow Coma Scale was positively associated with favorable outcome (per 1-point increment, OR 1.23, 95%CI 1.08-1.42). Sensitivity analyses conducted in operated patients revealed similar findings. Compared to normal CT, only moderate-to-severe ischemic stroke was associated with more frequent post-operative neurological complications (n = 8/23 (35%) vs n = 1/46 (2%), p < 0.01).
CONCLUSION
CONCLUSIONS
Moderate-to-severe ischemic stroke had an independent negative impact on 1-year functional outcome in critically ill IE patients; whereas other complications, including intracranial hemorrhage, had no such impact.
Identifiants
pubmed: 36583809
doi: 10.1186/s13613-022-01086-6
pii: 10.1186/s13613-022-01086-6
pmc: PMC9803797
doi:
Types de publication
Journal Article
Langues
eng
Pagination
119Informations de copyright
© 2022. The Author(s).
Références
Stroke. 2011 Aug;42(8):2276-9
pubmed: 21680905
Stroke. 2001 Feb;32(2):438-41
pubmed: 11157179
Eur Heart J. 2014 May;35(18):1195-204
pubmed: 23964033
Circulation. 2013 Jun 11;127(23):2272-84
pubmed: 23648777
J Clin Neurosci. 2019 Apr;62:222-225
pubmed: 30638783
Infection. 2015 Jun;43(3):287-95
pubmed: 25575463
Lancet Neurol. 2006 Jul;5(7):603-12
pubmed: 16781990
Eur J Cardiothorac Surg. 2016 Aug;50(2):374-82
pubmed: 26968761
Mayo Clin Proc. 2019 Jun;94(6):1024-1032
pubmed: 30922693
Circulation. 2015 Oct 13;132(15):1435-86
pubmed: 26373316
Eur Heart J. 2015 Nov 21;36(44):3075-3128
pubmed: 26320109
JAMA. 2017 Apr 25;317(16):1652-1660
pubmed: 28444279
Intensive Care Med. 2004 Nov;30(11):2046-52
pubmed: 15372147
Ann Intensive Care. 2015 Dec;5(1):45
pubmed: 26621197
Stroke. 2008 Sep;39(9):2485-90
pubmed: 18617663
Stroke. 2006 Aug;37(8):2094-9
pubmed: 16794213
JAMA. 2016 Feb 23;315(8):801-10
pubmed: 26903338
Eur J Cardiothorac Surg. 2016 May;49(5):e119-26
pubmed: 26888461
J Stroke Cerebrovasc Dis. 2017 Nov;26(11):2527-2535
pubmed: 28673812
Respir Care. 2013 Jun;58(6):1008-23
pubmed: 23709197
Crit Care. 2019 Apr 25;23(1):143
pubmed: 31027489
Stroke. 1999 Nov;30(11):2347-54
pubmed: 10548669
BMC Neurol. 2014 Feb 15;14:30
pubmed: 24528538
Ann Thorac Surg. 2011 Jun;91(6):2012-9
pubmed: 21620012
Lancet. 1974 Jul 13;2(7872):81-4
pubmed: 4136544
Eur Heart J. 2007 May;28(9):1155-61
pubmed: 17363448
Eur Neurol. 2018;80(3-4):171-178
pubmed: 30485851
Crit Care Med. 2011 Jun;39(6):1474-81
pubmed: 21358398
Eur Heart J. 2019 Oct 14;40(39):3222-3232
pubmed: 31504413
Front Neurol. 2017 Jan 12;7:245
pubmed: 28127292
Arch Intern Med. 2009 Mar 9;169(5):463-73
pubmed: 19273776
Stroke. 2000 Apr;31(4):858-62
pubmed: 10753988