Circulation：卒中和脑出血对感染性心内膜炎有负面影响

　　西班牙一项研究表明，中重度缺血性卒中和脑出血对感染性心内膜炎（IE）转归具有显著负面影响。研究进一步提示了早期适当地抗菌治疗的重要性，且应考虑暂时中断抗凝治疗。论文于5月6日在线发表于《循环》（Circulation）。

　　此项研究共纳入1345例次左侧IE发作，并对前瞻性采集的资料进行了回顾性分析。利用Cox回归模型分析神经系统并发症和相关死亡的预测变量。

　　结果显示，共有340例患者（25%）出现神经系统并发症，其中包括缺血性事件、脑病/脊膜炎、出血和脑脓肿。与所有神经系统并发症相关的独立危险因素包括赘生物≥3 cm、葡萄球菌病原菌、二尖瓣受累和抗凝治疗。抗凝治疗与出血性事件发生率升高尤为相关（危险比[HR] 2.71）。总体死亡率为30%，并且神经系统并发症对转归具有负面影响，但仅中重度缺血性卒中和脑出血与不良预后显著相关。抗生素治疗可降低神经系统并发症风险。在出血患者中，出血性事件4周内实施手术的患者死亡率较高。

与卒中相关的拓展阅读：

• Stroke:糖尿病患者卒中发生风险增高
• Neurology：卒中前使用他汀类药物减轻缺血性卒中的临床症状
• Am J Cardiol：急性冠脉综合征和缺血性卒中危险因素相似
• Stroke：梗死体积较血管再通情况能够更好地预测卒中预后 更多信息请点击：有关卒中更多资讯

Neurologic Complications of Infective Endocarditis: Risk Factors, Outcome, and Impact of Cardiac Surgery: A Multicenter Observational Study.
BACKGROUND
This study assesses the incidence of neurologic complications in IE patients, the risk factors for their development, their influence on the clinical outcome, and the impact of cardiac surgery.
METHODS AND RESULTS
Retrospective analysis of prospectively collected data on a multicenter cohort of 1345 consecutive episodes of left-sided IE from 8 centers in Spain. Cox regression models were developed to analyze variables predictive of neurologic complications and associated mortality. Three hundred and forty patients (25%) experienced such complications: 192 patients (14%) had ischemic events, 86 (6%) encephalopathy/meningitis, 60 (5%) hemorrhages, and 2 brain abscesses. Independent risk factors associated with all neurologic complications were: vegetation size ≥3 cm (HR 1.91), Staphylococcus aureus etiology (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 neurologic complications had a negative impact on the outcome (45% of deaths vs. 24% in patients without these complications; p<0.01), although only moderate-severe ischemic stroke (HR 1.63) and brain hemorrhage (HR 1.73) were significantly associated with a poorer prognosis. Antimicrobial treatment reduced (by 33%-75%) the risk of neurologic complications. In patients with hemorrhage, mortality was higher when surgery was performed within 4 weeks of the hemorrhagic event (75% vs 40% in later surgery).
CONCLUSIONS
Moderate-severe ischemic stroke and brain hemorrhage were found to have a significant negative impact on the outcome of IE. Early, appropriate antimicrobial treatment is critical, and transitory discontinuation of anticoagulant therapy should be considered.