Infective endocarditis with neurologic complications: 10-year experience

The impact of neurologic complications on clinical outcomes in infective endocarditis was assessed. Medical records of patients with infective endocarditis from January 1, 1987 through September 30,1998 were analyzed. Patients were divided into two groups: one with neurological complications and the other without. The outcomes of the two groups were compared using Fisher's exact test. Fifty-eight patients fulfilled the definite Duke criteria. There were 46 men and 12 women, ranging from 3 to 71 years of age with a mean of 40.6 years. Pathogens of infective endocarditis were documented by blood culture in 55 (94.8%) of 58 patients as follows: 52 with gram-positive cocci, two with gram-negative bacilli, and one with fungus. All 58 patients had initially received antimicrobial agents. Eight (13.8%) of the 58 patients had received surgical valvular replacement because of medical treatment failure. Overall, 16 (27.6%) of 58 patients died. Neurologic complications were either the chief complaint or one of the major presenting symptoms in 16 (27.6%) of the 58 patients. Patients with neurologic complications had a higher mortality rate (50% vs 20.9%, p = 0.025) than those without neurologic complications. The adjusted risk ratio for neurologic complications for a fatal event was 3.51 (95% CI = 1.1-11.18, p = 0.03). Neurologic complications pose a significant problem in infective endocarditis. To reduce mortality, we recommend that more attention be paid to the treatment and prevention of the neurologic complications of infective endocarditis.