Evaluation of cerebral neurological complications in patients with infective endocarditis: results of a single-center retrospective study

Abstract. Cerebral neurological complications (CNC) are the most common form of infective endocarditis (IE) extracardiac manifestations. They have important clinical implications, which justifies the need to study them.

Purpose of the study: to evaluate symptomatic CNC (prevalence, predictors, effect on the prognosis) in patients with «left-sided» IE who have undergone cardiac surgery, according to the register of the Federal Center for Cardiovascular Surgery.

Materials and methods. A retrospective review of data from the hospital information system was carried out in one of the Federal Centers for Cardiovascular Surgery of the Ministry of Health of the Russian Federation. In patients with significant/probable «left-sided» (mitral and/or aortic valves) acute/subacute IE at age of ≥ 18 years, the frequency of CNC and their subtypes was assessed, predictors and effect on the prognosis of the disease were determined. Differences between groups of patients depending on the status of the presence of CNC were assessed using the χ² test, Fisher’s exact test and the Mann–Whitney test. Binary cross tables were further analyzed to calculate the odds ratio (OR). Integral predictive models were also built using the logistic regression algorithm. To assess the effect of CNC on patient survival, Kaplan–Meier analysis was used with the construction of survival curves.

Results. For the analysis, 222 cases of IE in 216 patients were used. The incidence of CNC was 25.7% (19.4% – ischemic stroke, 5.4% – intracranial hemorrhage, 2.7% – meningitis, encephalitis and/or abscess). CNC predictors were embologenic vegetations: size > 10 mm (OR 6.3; 95% CI: 3.0–13.0), mobile (OR 8.5; 95% CI: 3.2–22.3) and multiple (OR 4.9; 95% CI: 2.1–11.4) vegetation; the level of white blood cells ≥ 10 × 109/L (OR 2.1, 1.1–3.8), as well as systemic embolism (OR 3.6; 95% CI: 1.6–7.9). The accuracy of the logistic regression model obtained using the above predictors was 83% (on the test set). No effect of CNC on the prognosis (in-hospital and long-term mortality, stroke in the long-term period) was found.

Conclusion. Neurological complications have a high prevalence, occurring in one in four patients with «left-sided» IE. Ischemic stroke is the most common subtype of CNC, and vegetation characteristics are a determining factor of the embologenic potential of endocarditis. There was no effect on the prognosis (in-hospital and long-term mortality) in patients undergoing cardiac surgery.

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