Stroke Associated with Infective Endocarditis. Frequency and Prognostic Implications

Abstract

Stroke can be one of the most severe complications of Infective Endocarditis (IE) and it happens in 14% of patients with IE. Therefore, we aimed to review stroke frequency in patients diagnosed with IE in our hospital from 2010 to 2020. We defined it as IE-Associated Stroke (IEAS) when the stroke happened one month before or after IE's diagnosis. Sixty-six patients were diagnosed with IE during this period time and 15 (22%) suffered IEAS: 13 ischemic strokes, one Subarachnoid Hemorrhage (SAH) and one parenchymal hemorrhage with SAH. Patients with IEAS were more frequently men (80% vs 51% p = 0.042) and had less atrial fibrillation (13.3% vs 37.3%, p = 0.071). Although not statistically significant, Streptococcus sp (53% vs. 44.9%) and Staphylococcus aureus (33.3% vs. 16.3%) were more frequent in patients with IEAS. Mortality was increased in patients with IEAS (60% vs 13.7%, p = 0.001) especially in patients where stroke diagnosis was posterior to IE (88.9% vs 16.7%, p = 0.011). Hypertension (93.8% vs 63%, p = 0.013) and diabetes (53.2% vs 30%, p0 = 0.052) were also more frequent in those patients who died. In multivariate analysis, hypertension (OR 13.7 95% CI 1.4-138.4) and IEAS (OR 12.8 95% CI 2.8-58) were independently associated with death. The frequency of IEAS in our patients is comparable to what has been described in the literature. IEAS was associated with increased mortality.