Erwan Salaun1, Anissa Touil2, Sandrine Hubert3, Jean-Paul Casalta3, Frédérique Gouriet3, Emmanuelle Robinet-Borgomano4, Emilie Doche4, Nadia Laksiri4, Caroline Rey4, Cécile Lavoute2, Sébastien Renard2, Hervé Brunel5, Anne-Claire Casalta2, Julie Pradier2, Jean-François Avierinos2, Hubert Lepidi3, Laurence Camoin-Jau6, Alberto Riberi3, Didier Raoult7, Gilbert Habib3. 1. Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France. Electronic address: salaun.er@gmail.com. 2. Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France. 3. Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France; MEPHI, IRD, IHU-Méditerranée Infection, Aix Marseille University, AP-HM, 13005 Marseille, France. 4. Neurology Department, la Timone Hospital, AP-HM, 13005 Marseille, France. 5. Radiology Department, la Timone Hospital, AP-HM, 13005 Marseille, France. 6. MEPHI, IRD, IHU-Méditerranée Infection, Aix Marseille University, AP-HM, 13005 Marseille, France; Department of Hematology, Aix Marseille University, la Timone Hospital, AP-HM, 13005 Marseille, France. 7. MEPHI, IRD, IHU-Méditerranée Infection, Aix Marseille University, AP-HM, 13005 Marseille, France.
Abstract
BACKGROUND: Although intracranial cerebral haemorrhage (ICH) complicating infective endocarditis (IE) is a critical clinical issue, its characteristics, impact, and prognosis remain poorly known. AIMS: To assess the incidence, mechanisms, risk factors and prognosis of ICH complicating left-sided IE. METHODS: In this single-centre study, 963 patients with possible or definite left-sided IE were included from January 2000 to December 2015. RESULTS: Sixty-eight (7%) patients had an ICH (mean age 57±13 years; 75% male). ICH was classified into three groups according to mechanism: ruptured mycotic aneurysm (n=22; 32%); haemorrhage after ischaemic stroke (n=27; 40%); and undetermined aetiology (n=19; 28%). Five variables were independently associated with ICH: platelet count<150×109/L (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.01-5.4; P=0.049); severe valve regurgitation (OR 3.2, 95% CI 1.3-7.6; P=0.008); ischaemic stroke (OR 4.2, 95% CI 1.9-9.4; P<0.001); other symptomatic systemic embolism (OR 14.1, 95% CI 5.1-38.9; P<0.001); and presence of mycotic aneurysm (OR 100.2, 95% CI 29.2-343.7; P<0.001). Overall, 237 (24.6%) patients died within 2.3 (0.7-10.4) months of follow-up. ICH was not associated with increased mortality (P not significant). However, the 1-year mortality rate differed according to ICH mechanism: 14%, 15% and 45% in patients with ruptured mycotic aneurysm, haemorrhage after ischaemic stroke and undetermined aetiology, respectively (P=0.03). In patients with an ICH, mortality was higher in non-operated versus operated patients when cardiac surgery was indicated (P=0.005). No operated patient had neurological deterioration. CONCLUSIONS: ICH is a common complication of left-sided IE. The impact on prognosis is dependent on mechanism (haemorrhage of undetermined aetiology). We observed a higher mortality rate in patients who had conservative treatment when cardiac surgery was indicated compared with in those who underwent cardiac surgery.
BACKGROUND: Although intracranial cerebral haemorrhage (ICH) complicating infective endocarditis (IE) is a critical clinical issue, its characteristics, impact, and prognosis remain poorly known. AIMS: To assess the incidence, mechanisms, risk factors and prognosis of ICH complicating left-sided IE. METHODS: In this single-centre study, 963 patients with possible or definite left-sided IE were included from January 2000 to December 2015. RESULTS: Sixty-eight (7%) patients had an ICH (mean age 57±13 years; 75% male). ICH was classified into three groups according to mechanism: ruptured mycotic aneurysm (n=22; 32%); haemorrhage after ischaemic stroke (n=27; 40%); and undetermined aetiology (n=19; 28%). Five variables were independently associated with ICH: platelet count<150×109/L (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.01-5.4; P=0.049); severe valve regurgitation (OR 3.2, 95% CI 1.3-7.6; P=0.008); ischaemic stroke (OR 4.2, 95% CI 1.9-9.4; P<0.001); other symptomatic systemic embolism (OR 14.1, 95% CI 5.1-38.9; P<0.001); and presence of mycotic aneurysm (OR 100.2, 95% CI 29.2-343.7; P<0.001). Overall, 237 (24.6%) patients died within 2.3 (0.7-10.4) months of follow-up. ICH was not associated with increased mortality (P not significant). However, the 1-year mortality rate differed according to ICH mechanism: 14%, 15% and 45% in patients with ruptured mycotic aneurysm, haemorrhage after ischaemic stroke and undetermined aetiology, respectively (P=0.03). In patients with an ICH, mortality was higher in non-operated versus operated patients when cardiac surgery was indicated (P=0.005). No operated patient had neurological deterioration. CONCLUSIONS:ICH is a common complication of left-sided IE. The impact on prognosis is dependent on mechanism (haemorrhage of undetermined aetiology). We observed a higher mortality rate in patients who had conservative treatment when cardiac surgery was indicated compared with in those who underwent cardiac surgery.
Authors: Umberto Maria Satriano; Antonio Nenna; Cristiano Spadaccio; Francesco Pollari; Theodor Fischlein; Massimo Chello; Francesco Nappi Journal: Ann Transl Med Date: 2020-12