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Volume 13
Issue 23
10.3390/jcm13237053
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Background:
Systematic Review

The Impact of Neurological Complications in Endocarditis: A Systematic Review and Meta-Analysis

by
Federico Sanguettoli
1,
Federico Marchini
1,
Federica Frascaro
1,
Luca Zanarelli
1,
Gianluca Campo
1,
Christoph Sinning
2,
Timothy C. Tan
3,4 and
Rita Pavasini
1,*
1
UO Cardiologia, Azienda Ospedaliero Universitaria di Ferrara, 44124 Ferrara, Italy
2
Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany
3
Department of Cardiology, Blacktown Hospital, Western Sydney University, Sydney 2148, Australia
4
Department of Cardiology, Westmead Hospital, Sydney University, Sydney 2148, Australia
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(23), 7053; https://doi.org/10.3390/jcm13237053
Submission received: 29 October 2024 / Revised: 14 November 2024 / Accepted: 20 November 2024 / Published: 22 November 2024
(This article belongs to the Section Cardiovascular Medicine)
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Abstract

Background: Infective endocarditis (IE) is associated with significant neurological complications (NCs). The impact of neurological sequelae due to IE, however, is not well characterized. Thus, the aim of this systematic review and meta-analysis is to determine whether patients who experienced NCs from IE had worse outcomes compared to those without neurological complications. Methods: We conducted a systematic and comprehensive literature search of MEDLINE, Cochrane Library, Google Scholar, and BioMed Central (PROSPERO registration ID: CRD42024518651). Data on the primary outcome of all-cause mortality and the secondary outcome of surgical timing were extracted from 25 observational studies on patients with confirmed IE, both with and without NC. Results: In the pooled total of patients with IE, NCs were present in 23.7% (60.8% ischaemic stroke and 16.4% haemorrhagic stroke). All-cause mortality was significantly higher in patients with IE and NCs (OR 1.78, CI 1.47–2.17, p < 0.0001) compared to those without, particularly in those with major neurological events (OR 2.18, CI 1.53–3.10, p < 0.0001). Conversely, minor or asymptomatic strokes showed no significant correlation with mortality (OR 1.10, CI 0.82–1.47, p = 0.543). There was no significant difference in the timing of surgical intervention (standardized mean difference −0.53, CI −1.67 to 0.61, p = 0.359) between the two patient groups. Conclusions: Major NCs due to infective endocarditis were associated with a significantly increased all-cause mortality. This underscores the critical importance of early recognition and management strategies tailored to the severity of neurological events.
Keywords: endocarditis; stroke; mortality; cardiac surgery endocarditis; stroke; mortality; cardiac surgery

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MDPI and ACS Style

Sanguettoli, F.; Marchini, F.; Frascaro, F.; Zanarelli, L.; Campo, G.; Sinning, C.; Tan, T.C.; Pavasini, R. The Impact of Neurological Complications in Endocarditis: A Systematic Review and Meta-Analysis. J. Clin. Med. 2024, 13, 7053. https://doi.org/10.3390/jcm13237053

AMA Style

Sanguettoli F, Marchini F, Frascaro F, Zanarelli L, Campo G, Sinning C, Tan TC, Pavasini R. The Impact of Neurological Complications in Endocarditis: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2024; 13(23):7053. https://doi.org/10.3390/jcm13237053

Chicago/Turabian Style

Sanguettoli, Federico, Federico Marchini, Federica Frascaro, Luca Zanarelli, Gianluca Campo, Christoph Sinning, Timothy C. Tan, and Rita Pavasini. 2024. "The Impact of Neurological Complications in Endocarditis: A Systematic Review and Meta-Analysis" Journal of Clinical Medicine 13, no. 23: 7053. https://doi.org/10.3390/jcm13237053

APA Style

Sanguettoli, F., Marchini, F., Frascaro, F., Zanarelli, L., Campo, G., Sinning, C., Tan, T. C., & Pavasini, R. (2024). The Impact of Neurological Complications in Endocarditis: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 13(23), 7053. https://doi.org/10.3390/jcm13237053

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