Please use this identifier to cite or link to this item: http://hdl.handle.net/10668/1646
Título : Neurological complications of infective endocarditis: risk factors, outcome, and impact of cardiac surgery: a multicenter observational study.
Autor : García-Cabrera, Emilio
Fernández-Hidalgo, Nuria
Almirante, Benito
Ivanova-Georgieva, Radka
Noureddine, Mariam
Plata, Antonio
Lomas, Jose M
Gálvez-Acebal, Juan
Hidalgo-Tenorio, Carmen
Ruíz-Morales, Josefa
Martínez-Marcos, Francisco J
Reguera, Jose M
Torre-Lima, Javier de La
Alarcón González, Arístides De
Filiación: [García-Cabrera,E; Fernández-Hidalgo,N; Almirante,B; Ivanova-Georgieva,R; Noureddine,M; Plata,A; Lomas,ML; Gálvez-Acebal,J; Hidalgo-Tenorio,C; Ruíz-Morales,J; Martínez-Marcos,FJ; Reguera,JM; Torre-Lima,J De La; Alarcón González,A De] Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain. [García-Cabrera,E; Alarcón González,A De] Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain. [Ivanova-Georgieva,R] Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain. [Fernández-Hidalgo,N; Almirante,B] Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Medicine Department, Barcelona. [Ruíz-Morales,J] Infectious Diseases Service, Hospital Universitario Virgen de la Victoria, Malaga, Spain. [Noureddine,M] Infectious Diseases Unit Hospital Costa del Sol, Marbella, Malaga, Spain. [Plata,A; Ruíz-Morales,J] Infectious Diseases Service, Hospital Universitario Carlos Haya Malaga. [Lomas,JM; Martínez-Marcos,FJ] Infectious Diseases Unit Hospital Juan Ramón Jiménez, Huelva, Spain. [Gálvez-Acebal,J] Clinical Service of Infectious Disease and Clinical Microbiology, Hospital Universitario Virgen Macarena, Seville, Spain. [Hidalgo-Tenorio,C] Infectious Diseases Service, Hospital Universitario Virgen de las Nieves, Granada, Spain. [Alarcón González,A De] Infectious Diseases, Microbiology and Preventive Medicine Department, Hospital Universitario Virgen del Rocío, Seville, Spain.
Grupo de Investigación: The Group for the Study of Cardiovascular Infections of the Andalusian Society of Infectious Diseases (SAEI) and the Spanish Network for Research in Infectious Diseases (REIPI)
Palabras clave : Endocardium
Infection
Nervous system
Complications
Antiinfecciosos
Absceso encefálico
Isquemia encefálica
Hemorragia cerebral
Terapia combinada
Comorbilidad
Encefalitis
Endocarditis
Estudios de seguimiento
Incidencia
Aneurisma Intracraneal
Meningitis
Estudios multicéntricos como Asunto
Complicaciones postoperatorias
Pronóstico
Modelos de riesgos Proporcionales
Estudios retrospectivos
Factores de riesgo
Infecciones estafilocócicas
Resultado del tratamiento
MeSH: Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Aged
Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Anticoagulants
Medical Subject Headings::Diseases::Bacterial Infections and Mycoses::Brain Abscess
Medical Subject Headings::Diseases::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Brain Ischemia
Medical Subject Headings::Diseases::Cardiovascular Diseases::Vascular Diseases::Cerebrovascular Disorders::Intracranial Hemorrhages::Cerebral Hemorrhage
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Combined Modality Therapy
Medical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Epidemiologic Factors::Comorbidity
Medical Subject Headings::Diseases::Virus Diseases::Central Nervous System Viral Diseases::Encephalitis
Medical Subject Headings::Diseases::Cardiovascular Diseases::Heart Diseases::Endocarditis
Medical Subject Headings::Check Tags::Female
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Follow-Up Studies
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Morbidity::Incidence
Medical Subject Headings::Diseases::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Intracranial Arterial Diseases::Intracranial Aneurysm
Medical Subject Headings::Check Tags::Male
Medical Subject Headings::Diseases::Nervous System Diseases::Central Nervous System Diseases::Meningitis
Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Middle Aged
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Clinical Trials as Topic::Multicenter Studies as Topic
Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Postoperative Complications
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Models, Statistical::Proportional Hazards Models
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Case-Control Studies::Retrospective Studies
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors
Medical Subject Headings::Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Positive Bacterial Infections::Staphylococcal Infections
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome
Medical Subject Headings::Named Groups::Persons::Age Groups::Adult
Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents
Fecha de publicación : 11-Jun-2013
Editorial : American Heart Association
Cita Bibliográfica: García-Cabrera E, Fernández-Hidalgo N, Almirante B, Ivanova-Georgieva R, Noureddine M, Plata A, et al. Neurological complications of infective endocarditis: risk factors, outcome, and impact of cardiac surgery: a multicenter observational study. Circulation. 2013;127(23):2272-84
Abstract: BACKGROUND The purpose of this study was to assess the incidence of neurological complications in patients with infective endocarditis, the risk factors for their development, their influence on the clinical outcome, and the impact of cardiac surgery. METHODS AND RESULTS This was a retrospective analysis of prospectively collected data on a multicenter cohort of 1345 consecutive episodes of left-sided infective endocarditis from 8 centers in Spain. Cox regression models were developed to analyze variables predictive of neurological complications and associated mortality. Three hundred forty patients (25%) experienced such complications: 192 patients (14%) had ischemic events, 86 (6%) had encephalopathy/meningitis, 60 (4%) had hemorrhages, and 2 (1%) had brain abscesses. Independent risk factors associated with all neurological complications were vegetation size ≥3 cm (hazard ratio [HR] 1.91), Staphylococcus aureus as a cause (HR 2.47), mitral valve involvement (HR 1.29), and anticoagulant therapy (HR 1.31). This last variable was particularly related to a greater incidence of hemorrhagic events (HR 2.71). Overall mortality was 30%, and neurological complications had a negative impact on outcome (45% of deaths versus 24% in patients without these complications; P<0.01), although only moderate to severe ischemic stroke (HR 1.63) and brain hemorrhage (HR 1.73) were significantly associated with a poorer prognosis. Antimicrobial treatment reduced (by 33% to 75%) the risk of neurological complications. In patients with hemorrhage, mortality was higher when surgery was performed within 4 weeks of the hemorrhagic event (75% versus 40% in later surgery). CONCLUSIONS Moderate to severe ischemic stroke and brain hemorrhage were found to have a significant negative impact on the outcome of infective endocarditis. Early appropriate antimicrobial treatment is critical, and transitory discontinuation of anticoagulant therapy should be considered.
Descripción : Journal Article;
URI: http://hdl.handle.net/10668/1646
Versión del editor : http://circ.ahajournals.org/content/127/23/2272.abstract
DOI: 10.1161/CIRCULATIONAHA.112.000813
ISSN : 1524-4539 (Online)
0009-7322 (Print)
Appears in Collections:01- Artículos - Hospital Virgen Macarena
01- Artículos - Hospital Juan Ramón Jiménez
01- Artículos - Hospital Regional de Málaga
01- Artículos - APES Costa del Sol
01- Artículos - Hospital Virgen de la Victoria
01- Artículos - Hospital Virgen del Rocío
01- Artículos - IBIS. Instituto de Biomedicina de Sevilla
01- Artículos - Hospital Virgen de las Nieves

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