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- Emilio García-Cabrera
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall...
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- Nuria Fernández-Hidalgo
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall...
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- Benito Almirante
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall...
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- Radka Ivanova-Georgieva
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall...
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- Mariam Noureddine
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall...
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- Antonio Plata
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall...
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- Jose M. Lomas
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall...
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- Juan Gálvez-Acebal
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall...
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- Carmen Hidalgo-Tenorio
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall...
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- Josefa Ruíz-Morales
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall...
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- Francisco J. Martínez-Marcos
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall...
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- Jose M. Reguera
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall...
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- Javier de la Torre-Lima
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall...
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- Arístides de Alarcón González
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall...
書誌事項
- タイトル別名
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- Risk Factors, Outcome, and Impact of Cardiac Surgery: A Multicenter Observational Study
説明
<jats:sec> <jats:title>Background—</jats:title> <jats:p>The purpose of this study was to assess the incidence of neurological complications in patients with infective endocarditis, the risk factors for their development, their influence on the clinical outcome, and the impact of cardiac surgery.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p> This was a retrospective analysis of prospectively collected data on a multicenter cohort of 1345 consecutive episodes of left-sided infective endocarditis from 8 centers in Spain. Cox regression models were developed to analyze variables predictive of neurological complications and associated mortality. Three hundred forty patients (25%) experienced such complications: 192 patients (14%) had ischemic events, 86 (6%) had encephalopathy/meningitis, 60 (4%) had hemorrhages, and 2 (1%) had brain abscesses. Independent risk factors associated with all neurological complications were vegetation size ≥3 cm (hazard ratio [HR] 1.91), <jats:italic>Staphylococcus aureus</jats:italic> as a cause (HR 2.47), mitral valve involvement (HR 1.29), and anticoagulant therapy (HR 1.31). This last variable was particularly related to a greater incidence of hemorrhagic events (HR 2.71). Overall mortality was 30%, and neurological complications had a negative impact on outcome (45% of deaths versus 24% in patients without these complications; <jats:italic>P</jats:italic> <0.01), although only moderate to severe ischemic stroke (HR 1.63) and brain hemorrhage (HR 1.73) were significantly associated with a poorer prognosis. Antimicrobial treatment reduced (by 33% to 75%) the risk of neurological complications. In patients with hemorrhage, mortality was higher when surgery was performed within 4 weeks of the hemorrhagic event (75% versus 40% in later surgery). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>Moderate to severe ischemic stroke and brain hemorrhage were found to have a significant negative impact on the outcome of infective endocarditis. Early appropriate antimicrobial treatment is critical, and transitory discontinuation of anticoagulant therapy should be considered.</jats:p> </jats:sec>
収録刊行物
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- Circulation
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Circulation 127 (23), 2272-2284, 2013-06-11
Ovid Technologies (Wolters Kluwer Health)
