Significant Increase in Mortality and Risk of Acute Ischemic Stroke in Infective Endocarditis Patients With Subarachnoid Hemorrhage

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

4-13-2021

Journal Title

Neurology

Department

Neurology

Abstract

Objective:

To study a large cohort of Infective Endocarditis (IE) patients, to evaluate the rate of acute ischemic stroke (AIS) in patients with and without subarachnoid hemorrhage (SAH).

Background:

IE-patients are well-known to have a variety of complications, one of the most serious being cerebral mycotic aneurysm, which may result in SAH. Here we seek to understand the impact of SAH on the outcomes and complications of these patients.

Design/Methods:

Data obtained from National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. We conducted a retrospective cohort study from 2010 to 2015 on patients whose primary diagnosis was IE. Our primary comparison was between the group of IE-patients with SAH and those without SAH. Statistical methods for the below results were all performed using Stata, including chi-square and logistic regression.

Results:

We identified 82,844 IE-patients, of which 641 had a concurrent diagnosis of SAH. IE-patients with SAH, had a more complicated course, higher mortality risk (OR 4.65 CI95% 3.9–5.5, p<0.001), and worse outcome measures. 23/641 (3.6%) IE-patients with SAH underwent endovascular therapy for a mycotic aneurysm. IE-patients with SAH were also more likely to have a diagnosis of ventriculitis (OR 7.1 CI95% 4.2–11.9, p<0.001). IE-patients with SAH were found to have a significantly higher rate of AIS (OR 6.3 CI95% 5.4–7.4, p<0.001). While the cohort of all IE-patients had a 10.1% rate (8267/82,203 patients) of AIS during their hospitalization, IE-patients with SAH had a 41.5% rate (266/641 patients). 0.8% of the IE-patients with AIS underwent mechanical thrombectomy; however, the rate of thrombectomy was higher in the SAH group (1.9%, p=0.05).

Conclusions:

IE-patients are at risk for numerous complications, and this study suggests a significant increase in the mortality and risk of AIS in IE-patients with SAH. Disclosure: Tolga Sursal has nothing to disclose. Zafar Karimov has nothing to disclose. Andrew Nazarenko has nothing to disclose. Linda Ye has nothing to disclose. Dr. Al-Mufti has nothing to disclose.

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