Keele Research Repository

BACKGROUND: There is lack of data on the association between infective endocarditis (IE) and outcomes of mortality and complications is stroke. We aimed to compare characteristics and outcomes of stroke patients with and without IE. METHODS: We retrospectively examined the above association using data obtained from an insurance database which covers ~75% of the Thai population. All hospitalized strokes between 8th January 2003 and 31st December 2013 were included in the current study. Characteristics and outcomes were compared between stroke patients with or without IE, and then between two main stroke types. Multiple logistic regression models including propensity score matched analyses were constructed to assess study outcomes controlling for age, sex, stroke type and co-morbidities. RESULTS: A total of 590,115 stroke patients (mean (SD) age = 64.2±13.7 years) (ischemic = 51.7%; hemorrhagic=32.6%; undetermined=15.7%) were included, of whom 2,129(0.36%) had stroke associated with IE. After adjustment, we found that IE was significantly associated with the following complications: arrhythmias (adjusted odds ratio (95% CI) 6.94(6.29-7.66)), sepsis (1.24(1.01-1.52)), pneumonia (1.34(1.17-1.53)), respiratory failure (1.43(1.24-1.66)) and in-hospital mortality (1.29(1.13-1.47)) (p for all<0.001). Patients with hemorrhagic stroke with IE had poorer outcomes for in-hospital mortality and respiratory failure compared to their counterparts with ischemic stroke. Propensity score matched analysis showed similar results. CONCLUSIONS: Our results suggest that stroke patients with infective endocarditis differ from that of the general stroke population and these patients have worse outcomes. Future studies are needed to determine the best treatment strategies for stroke patients with infective endocarditis.