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Pre-operative stroke and neurological disability do not independently affect short- and long-term mortality in infective endocarditis patients

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Abstract

Background

Infective endocarditis (IE) is still associated with high morbidity and mortality. The impact of pre-operative stroke on mortality and long-term survival is controversial. In addition, data on the severity of neurological disability due to pre-operative stroke are scarce. We analysed the impact of pre-operative stroke and the severity of its related neurological disability on short- and long-term outcome.

Methods

We retrospectively reviewed our data from patients operated for left-sided IE between 01/2007 and 04/2013. We performed univariate (Chi-Square and independent samples t test) and multivariate analyses.

Results

Among 308 consecutive patients who underwent cardiac surgery for left-sided IE, pre-operative stroke was present in 87 (28.2 %) patients. Patients with pre-operative stroke had a higher pre-operative risk profile than patient without it: higher Charlson comorbidity index (8.1 ± 2.6 vs. 6.6 ± 3.3) and higher incidence of Staphylococcus aureus infection (43 vs. 17 %) and septic shock (37 vs. 19 %). In-hospital mortality was equal but 5-year survival was significantly worse with pre-operative stroke (33.1 % vs. 45 %, p = 0.006). 5-year survival was worst in patients with severe neurological disability compared to mild disability (19.0 vs. 0.58 %, p = 0.002). However, neither pre-operative stroke nor the degree of neurological disability appeared as an independent risk factor for short or long-term mortality by multivariate analysis.

Conclusions

Pre-operative stroke and the severity of neurological disability do not independently affect short- and long-term mortality in patients with infective endocarditis. It appears that patients with pre-operative stroke present with a generally higher risk profile. This information may substantially affect decision-making.

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Acknowledgments

We wish to thank Johannes Hedderich for help preparing the data and Benjamin Gloy for assistance.

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    Authors and Affiliations

    1. Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, Erlanger Allee 101, 07747, Jena, Germany

      Mahmoud Diab, Gloria Faerber, Anna Matz & Torsten Doenst

    2. Department of Neurology, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany

      Albrecht Guenther & Otto W. Witte

    3. Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany

      Christoph Sponholz

    4. Center of Clinical Studies, Department of Cardiology, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany

      Thomas Lehmann

    5. Center for Infectious Diseases and Infection Control, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany

      Marcus Franz & Mathias W. Pletz

    6. Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt

      Mahmoud Diab

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    1. Mahmoud Diab
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    Correspondence to Torsten Doenst.

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    MWP was supported by Grants from the German Ministry of Education and Research (BMBF), Grant Numbers 01KI1204 and 01KI1501.

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    M. Diab and A. Guenther are contributed equally to this work.

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    Diab, M., Guenther, A., Sponholz, C. et al. Pre-operative stroke and neurological disability do not independently affect short- and long-term mortality in infective endocarditis patients. Clin Res Cardiol 105, 847–857 (2016). https://doi.org/10.1007/s00392-016-0993-x

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