Clinical Risk Factors for Acute Ischemic and Hemorrhagic Stroke in Patients with Infective Endocarditis.

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Clinical Risk Factors for Acute Ischemic and Hemorrhagic Stroke in Patients with Infective Endocarditis.

Intern Med J. 2018 May 09;:

Authors: Valenzuela I, Hunter MD, Sundheim K, Klein B, Dunn L, Sorabella R, Han SM, Willey J, George I, Gutierrez J

Abstract
BACKGROUND: Stroke as a complication of infective endocarditis portends a poor prognosis, yet risk factors for stroke subtype have not been well defined.
AIM: To identify risk factors associated with ischemic and hemorrhagic strokes.
METHODS: A retrospective patient chart review was performed at a single U.S. academic center to identify risk factors and imaging for patients 18 years or older with infectious endocarditis and stroke diagnoses. Differences in patient characteristics by stroke status were assessed with univariate analysis, Chi squared or student T-test as well as logistic regression models for multivariable analyses and correlation matrices to identify possible collinearity between variables and to obtain odd ratios (OR) and their 95% confidence intervals.
RESULTS: A final sample of 1157 was used for this analysis. The total number of non-surgical strokes was 178 with a prevalence of 15.4% (78% ischemic, 10% parenchymal hemorrhages, 8% subarachnoid hemorrhages, and 4% mixed ischemic/hemorrhagic). Multivariate risk factors for ischemic stroke included prior stroke (OR 2.0, 1.3-3.1), Staphylococcus infection (OR 2.0, 1.3-3.0), mitral vegetations (OR 2.2, 1.4-3.3) and valvular abscess (OR 2.7, 1.7-4.3). Risk factors for hemorrhagic stroke included fungal infection (OR 6.4, 1.2-34.0), male sex (OR 3.5, 1.4-8.3) and rheumatic heart disease (OR 3.3, 1.1-10.4).
CONCLUSIONS: Among patients with infectious endocarditis, there exist characteristics that relate differentially to ischemic and hemorrhagic stroke risk.

PMID: 29740951 [PubMed - as supplied by publisher]

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