Highlights
- •Endocarditis prevalence in acute stroke patients is 1.0%.
- •Certain laboratory and clinical parameters are early predictors of endocarditis.
- •Patients with acute stroke and endocarditis have a poor outcome at discharge.
Abstract
Study objectives
The primary objective of our study is to assess the endocarditis prevalence in patients
admitted to the emergency department (ED) for a primary diagnosis of acute stroke
(AS). Secondary objectives are the identification of early markers of endocarditis
in AS patients and the analysis of the short-term outcome of this population.
Methods
In this observational, retrospective, cohort study we enrolled consecutive adult patients
with a primary diagnosis of AS admitted to the Stroke Unit or to the Neurological
Intensive Care Unit of our hospital who were then discharged with a diagnosis of endocarditis.
These patients were then compared with age and sex-matched controls with a diagnosis
of AS and atrial fibrillation.
Results
Endocarditis prevalence in patients admitted to the Stroke Unit or Neurological Intensive
Care Unit with a primary diagnosis of AS is 1.0% (95% confidence interval 0.61-1.55).
Fever on ED admission, concomitant cancer, low hemoglobin, low lymphocyte levels,
a high neutrophils count and erythrocyte sedimentation levels could early differentiate
among AS patients, those with endocarditis from those with atrial fibrillation. A
moderate-to-severe valvular regurgitation is strongly suggestive of endocarditis.
The short term-outcome is markedly worse in endocarditis patients compared to patients
with atrial fibrillation, in terms of in-hospital mortality and discharge disability.
Conclusions
Endocarditis prevalence in patients admitted for a primary diagnosis of AS is low,
but this etiology leads to a poor outcome. Some laboratory, clinical-epidemiological
and echocardiographic parameters may help the physician to early recognize this condition
and, consequently, to promptly start an antibiotic therapy.
Keywords
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Article info
Publication history
Published online: January 17, 2023
Accepted:
January 3,
2023
Received in revised form:
December 25,
2022
Received:
August 29,
2022
Footnotes
Institutions: The patients were recruited in the Stroke Unit and in the Neurological Intensive Care Unit of Fondazione Policlinico Universitario A. Gemelli, Rome, Italy. This work was performed in the department of neuroscience of Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
Grant Support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.106977
Copyright
© 2023 Elsevier Inc. All rights reserved.
