Significant increase in mortality and risk of acute ischemic stroke in infective endocarditis patients with subarachnoid hemorrhage secondary to mycotic aneurysms

J Neurol Sci. 2023 Aug 15:451:120670. doi: 10.1016/j.jns.2023.120670. Epub 2023 May 10.

Abstract

Infective Endocarditis (IE) patients are known to have a variety of complications with one of the rarest, but serious being cerebral mycotic aneurysm, which can result in subarachnoid hemorrhage (SAH). Using the National In-Patient Sample database, we sought to determine the rate of acute ischemic stroke (AIS) and outcomes in IE- patients with and without SAH. In total, we identified 82,844 IE-patients from 2010 to 2016, of which 641 had a concurrent diagnosis of SAH. IE patients with SAH had a more complicated course, higher mortality rate (OR 4.65 CI 95% 3.9-5.5, P < 0.001), and worse outcomes. This patient population also had a significantly higher rate of AIS (OR 6.3 CI 95% 5.4-7.4, P < 0.001). Overall, 41.5% of IE-patients with SAH had AIS during their hospitalization as compared to 10.1% of IE only patients. IE-patients with SAH were more likely to undergo endovascular treatment (3.6%) with 0.8% of the IE patients with AIS undergoing mechanical thrombectomy. While IE-patients are at risk for various complications, our study suggests a significant increase in the mortality and risk of AIS in those with SAH.

Keywords: Acute ischemic stroke; Infective endocarditis; National inpatient sample; Subarachnoid hemorrhage.

MeSH terms

  • Aneurysm, Infected* / complications
  • Endocarditis* / complications
  • Endocarditis, Bacterial* / complications
  • Humans
  • Ischemic Stroke*
  • Stroke* / complications
  • Stroke* / epidemiology
  • Subarachnoid Hemorrhage* / complications