학술논문
Critically ill patients with infective endocarditis, neurological complications and indication for cardiac surgery: a multicenter propensity-adjusted study.
Document Type
Article
Author
Gros, Alexandre; Seguy, Benjamin; Bonnet, Guillaume; Guettard, Yves-Olivier; Pillois, Xavier; Prevel, Renaud; Orieux, Arthur; Ternacle, Julien; Préau, Sebastien; Lavie-Badie, Yoan; Coupez, Elisabeth; Coudroy, Rémi; Marest, Delphine; Martins, Raphaël P.; Gruson, Didier; Tourdias, Thomas; Boyer, Alexandre; the ICE-COCA investigators; Coste, Pierre; Fukutomi, Hikaru
Source
Subject
*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
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Language
ISSN
2110-5820
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]