부산대학교 도서관

Background:Cerebrovascular complications (ischemic stroke (IS), intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH)) of infective endocarditis (IE) are common and substantially increase morbidity and mortality. We aimed to identify risk factors for stroke in a nationally representative population of hospitalized IE patients from the US.Methods:Patient hospitalizations for IE and stroke were identified using validated International Classification of Diseases 10 diagnosis codes from the Q4 2015-2018 National Inpatient Sample. We evaluated the association between demographics, known risk factors (opioid use, cardiac valve replacement, and mitral valve disease), and Elixhauser comorbidity index-defined factors with the diagnosis of stroke using logistic regression.Results:Of the 53,557 patients with a diagnosis of IE, 5,754 (10.7%) had a concurrent diagnosis of stroke (75% IS, 6.9% ICH, 4.5% SAH, 14% multiple stroke types). The mean age at IE diagnosis was 59 years; 42.3% were female; 71.8% Caucasian, 14.2% Black, 7.8% Hispanic, 2.7% Asian, and 0.8% Native American; 9.2% of patients died during hospitalization (7.5% without stroke, 23% with stroke, p<0.001). Factors independently associated with stroke are shown in the Table; the C-statistic was 0.63. Opioid use and cardiac valve replacement were not associated with stroke.Conclusion:In this large, nationally representative sample of hospitalized IE patients, comorbidities independently associated with higher odds of stroke included mitral valve disease, metastatic cancer, coagulopathy, weight loss, and electrolyte disorders. Detailed clinical data, not available from this administrative data set, may allow better prediction of stroke, but our findings may suggest areas for additional research.