Neurologic complications and outcomes of infective endocarditis in critically ill patients: The ENDOcardite en REAnimation prospective multicenter study*

• DOI: 10.1097/ccm.0b013e3182120b41
• Publication Date: 2011-02-25T08:17:57Z
• Authors: Romain Sonneville; Mariana Mirabel; David Hajage; Florence Tubach; Philippe Vignon; Pierre Perez; Sylvain Lavoué; Achille Kouatchet; Olivier Pajot; Armand Mekontso D...; Jean-Marie Tonnelier; Pierre-Edouard Bo...; Jean-Pierre Frat; Jean-Christophe N...; Hervé Hyvernat; Ali Ait Hssain; Alexis Tabah; Jean-Louis Trouillet; Michel Wolff
• Keywords: Infective Endocarditis; Stroke

Objective: To describe the clinical spectrum of infective endocarditis in critically ill patients and assess impact neurologic complications on outcomes. Design: Prospective multicenter observational study conducted from April 2007 to October 2008. Setting: Thirty-three intensive care units 23 university-affiliated 10 general French hospitals. Patients: Two hundred twenty-five with definite IE were studied. Factors associated predictors 3-month mortality identified by logistic regression analysis. Functional outcomes evaluated modified Rankin Scale. Interventions: None. Measurements Main Results: Among 198 left-sided endocarditis, 108 (55%) experienced at least one complication. These ischemic stroke (n = 79), cerebral hemorrhage 53), meningitis or meningeal reaction 41), brain abscess 14), mycotic aneurysm 10). independently (subhazard ratio [95% confidence interval]): Staphylococcus aureus (1.45 [1.02–2.05]), mitral valve (1.54 [1.07–2.21]), nonneurologic embolic events (1.51 [1.09–2.09]). In contrast, health care-associated had a protective effect (0.46 [0.27–0.77]). Multivariate analysis three variables (odds failure, as defined Glasgow Coma Scale <10 (7.41 [2.89–18.96]), S. (3.26 [1.53–6.94]), severe comorbidities before admission Charlson score >2 (3.16 [1.47–6.77]). 106 assessed follow-up (3.9 [3–8.5] months), 31 (29%) ≤3 (ability walk without assistance), nine (9%) 4 5 (severe disability), 66 (62%) 6 (death). Conclusions: Neurologic are most frequent requiring unit admission. They contribute prognosis, leaving less than one-third alive functional independence. failure represents major determinant regardless underlying