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Critically ill patients with infective endocarditis, neurological complications and indication for cardiac surgery: a multicenter propensity-adjusted study.
- Source :
- Annals of Intensive Care; 2/2/2024, Vol. 14 Issue 1, p1-13, 13p
- Publication Year :
- 2024
-
Abstract
- Background: The benefit–risk balance and optimal timing of surgery for severe infective endocarditis (IE) with ischemic or hemorrhagic strokes is unknown. The study aim was to compare the neurological outcome between patients receiving surgery or not. Methods: In a prospective register-based multicenter ICU study, patients were included if they met the following criteria: (i) left-sided IE with an indication for heart surgery; (ii) with cerebral complications documented by cerebral imaging before cardiac surgery; (iii) with Sequential Organ Failure Assessment score ≥ 3. Exclusion criteria were isolated right-sided IE, in-hospital acquired IE and patients with cerebral complications only after cardiac surgery. In the primary analysis, the prognostic value of surgery in term of disability at 6 month was assessed by using a propensity score-adjusted logistic regression. Results: 192 patients were included including ischemic stroke (74.5%) and hemorrhagic lesion (15.6%): 67 (35%) had medical treatment and 125 (65%) cardiac surgery. In the propensity score-adjusted logistic regression, a favorable 6-month neurological outcome was associated with surgery (odds ratio 13.8 (95% CI 6.2–33.7). The 1-year mortality was strongly reduced with surgery in the fixed-effect propensity-adjusted Cox model (hazard ratio 0.18; 95% CI 0.11–0.27; p < 0.001). These effects remained whether the patients received delayed surgery (n = 62/125) or not and whether they were deeply comatose (Glasgow Coma Scale ≤ 10) or not. Conclusions: In critically ill IE patients with an indication for surgery and previous cerebral events, a better propensity-adjusted neurological outcome was associated with surgery compared with medical treatment. [ABSTRACT FROM AUTHOR]
- Subjects :
- CARDIAC surgery
RESEARCH
INTENSIVE care units
ENTEROCOCCAL infections
HEMORRHAGIC stroke
CONFIDENCE intervals
ACADEMIC medical centers
ISCHEMIC stroke
CRITICALLY ill
LOG-rank test
PATIENTS
INTERVIEWING
MANN Whitney U Test
FISHER exact test
STREPTOCOCCAL diseases
CROSS infection
MAGNETIC resonance imaging
INFECTIVE endocarditis
RISK assessment
TREATMENT effectiveness
HOSPITAL mortality
STAPHYLOCOCCAL diseases
SEVERITY of illness index
T-test (Statistics)
COMPARATIVE studies
GLASGOW Coma Scale
CHI-squared test
KAPLAN-Meier estimator
SURVIVAL analysis (Biometry)
LOGISTIC regression analysis
ODDS ratio
DATA analysis software
LONGITUDINAL method
PROPORTIONAL hazards models
DISEASE complications
Subjects
Details
- Language :
- English
- ISSN :
- 21105820
- Volume :
- 14
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- Annals of Intensive Care
- Publication Type :
- Academic Journal
- Accession number :
- 175233172
- Full Text :
- https://doi.org/10.1186/s13613-023-01221-x