Table 4.
Predictors of Embolic Events Detected by Cerebral Imaging Among Patients With Infective Endocarditis
| Without CEE (n = 143) | With CEE (n = 187) | P | |||
|---|---|---|---|---|---|
| Demographics | |||||
| Male sex | 109 | 76% | 137 | 73% | .610 |
| Age (y) | 65 | 48–74 | 67 | 55–75 | .358 |
| Comorbidities | |||||
| Atrial fibrillation | 32 | 22% | 39 | 21% | .787 |
| Congestive heart failure | 18 | 13% | 11 | 6% | .048 |
| Chronic obstructive pulmonary disease | 19 | 13% | 22 | 12% | .747 |
| Cirrhosis | 13 | 9% | 11 | 6% | .290 |
| Diabetes mellitus | 43 | 30% | 43 | 23% | .165 |
| Chronic kidney disease (moderate or severe) | 18 | 13% | 28 | 15% | .631 |
| Malignancy (solid organ or hematologic) | 14 | 10% | 14 | 7% | .551 |
| Obesity | 39 | 27% | 37 | 20% | .115 |
| Immunosuppression | 12 | 8% | 14 | 7% | .838 |
| Antithrombotic or anticoagulation treatment | 72 | 50% | 91 | 49% | .824 |
| Antithrombotic treatment | 44 | 31% | 51 | 27% | .540 |
| Anticoagulation treatment | 43 | 30% | 50 | 27% | .538 |
| Setting of infection onset | |||||
| Community or non-nosocomial healthcare-associated | 130 | 91% | 173 | 93% | |
| Nosocomial | 13 | 9% | 14 | 8% | .686 |
| Cardiac predisposing factors | 74 | 52% | 94 | 50% | .825 |
| Prosthetic valve | 39 | 27% | 57 | 30% | .543 |
| Timing of IE | |||||
| 2015–2017 (retrospective cohort) | 50 | 35% | 67 | 36 | |
| 2018–2022 (prospective cohort) | 93 | 65 | 120 | 42 | .908 |
| Microbiological identification | |||||
| Staphylococcus aureus | 64 | 45% | 77 | 41% | .575 |
| Coagulase negative staphylococci | 10 | 7% | 6 | 3% | .127 |
| Streptococci | 35 | 24% | 60 | 32% | .142 |
| Enterococci | 17 | 12% | 21 | 11% | .863 |
| Other gram-positive | 5 | 3% | 3 | 2% | .300 |
| HACEK | 6 | 4% | 5 | 3% | .541 |
| Other gram-negative | 5 | 3% | 3 | 2% | .300 |
| Intracellular pathogens | 0 | 0% | 3 | 2% | .261 |
| Fungi | 2 | 1% | 3 | 2% | 1.000 |
| Polymicrobial infection | 4 | 3% | 2 | 1% | .409 |
| No identification | 4 | 3% | 8 | 4% | .563 |
| Manifestations | |||||
| Systemic symptoms | 134 | 94% | 175 | 94% | 1.000 |
| Fever | 120 | 84% | 153 | 82% | .661 |
| Heart murmur | 90 | 63% | 116 | 62% | .909 |
| New heart murmur | 63 | 44% | 91 | 49% | .437 |
| Immunologic phenomena | 10 | 7% | 25 | 13% | .072 |
| Sepsis | 62 | 43% | 92 | 49% | .317 |
| Septic shock | 29 | 20% | 37 | 20% | 1.000 |
| Cerebral imaging performed due to neurologic symptoms | 48 | 34% | 127 | 68% | <.001 |
| Deficit | 11 | 8% | 71 | 38% | <.001 |
| Confusion/coma | 31 | 22% | 72 | 39% | .001 |
| Headache | 7 | 5% | 14 | 7% | .373 |
| Seizures | 0 | 0% | 4 | 2% | .136 |
| Days to cerebral imaging | 4 | 1–8 | 2 | 0–5 | <.001 |
| Embolic events prior to cerebral imaging | 53 | 37% | 67 | 36% | .819 |
| Cutaneous | 13 | 9% | 17 | 9% | 1.000 |
| Ocular | 2 | 1% | 14 | 7% | .010 |
| Thoracoabdominal | 43 | 30% | 55 | 29% | .904 |
| Site of infection | |||||
| Aortic valve | 74 | 52% | 94 | 50% | .825 |
| Mitral valve | 52 | 36% | 105 | 56% | <.001 |
| Other left-side site of infection | 1 | 1% | 1 | 1% | 1.000 |
| Tricuspid valve | 18 | 13% | 9 | 5% | .014 |
| Pulmonary valve | 7 | 5% | 1 | 1% | .023 |
| Multivalvular | 17 | 12% | 23 | 12% | 1.000 |
| CIED-IE | 14 | 10% | 7 | 4% | .039 |
| Type of left-side valve | |||||
| Native | 100 | 70% | 138 | 74% | .459 |
| Prosthetic | 34 | 24% | 52 | 28% | .449 |
| Positive imaging Duke criterion | 115 | 80% | 156 | 83% | .562 |
| Vegetation | 102 | 71% | 141 | 75% | .450 |
| Vegetation ≥10 mm | 61 | 43% | 92 | 49% | .002 |
| Abscess | 27 | 19% | 56 | 30% | .029 |
| Other lesionsa | 24 | 17% | 42 | 22% | .214 |
Data are depicted as number/percentage or median/Q1–Q3.
Abbreviations: CEE, cerebral embolic events; CIED-IE, cardiac implantable electronic device-related infective endocarditis; EE, embolic events; HACEK, Haemophilus spp., Aggregatibacter spp., Cardiobacterium hominis, Eikenella corrodens, Kingella kingae; IE, infective endocarditis.
Perforation, dehiscence of prosthetic valve, fistula, pseudoaneurysm, aneurysm.