Journal of Cardiac Surgery

Research Article

The Influence of Preoperative Neurological Complications on Outcomes after Surgery for Infective Endocarditis

Table 1

(a) Demographic characteristics of the study population. (b) Clinical presentation data. (c) Specific endocarditis data. (d) Preoperative laboratory parameters.


(a)
	All patients (n = 438)	No neurological complications preoperative (n = 349, 79.7%)	Neurological complications preoperative (n = 89, 20.3%)	value

Age, years	61.0 ± 14.9	61.0 ± 14.9	61.1 ± 15.0	0.964
Age, years	64 (52; 73)	64 (52; 73)	64 (53; 74)	0.964
Female gender	112 (25.6%)	82 (23.5%)	30 (33.7%)	0.049
Body mass index (kg/m²)	25.9 (23.0; 29.4)	26.1 (23.2; 29.8)	24.7 (22.6; 28.7)	0.122
Logistic EuroSCORE I	25.0 (11.0; 45.7)	24.2 (9.2; 44.9)	26.8 (15.9; 51.6)	0.042
EuroSCORE II	11.5 (4.5; 25.5)	11.8 (4.8; 26.0)	8.7 (3.9; 25.2)	0.353
COPD	55 (12.6%)	43 (12.3%)	12 (13.5%)	0.768
Arterial hypertension	257 (58.7%)	213 (61.0%)	44 (49.4%)	0.047
Ejection fraction (%)	55 (50; 56)	55 (48; 56)	55 (50; 60)	0.263
LVEF poor (<30)	40 (9.3%)	34 (10.0%)	6 (6.8%)	0.365
Atrial fibrillation	83 (18.9%)	61 (17.5%)	22 (24.7%)	0.120
Peripheral vascular disease	38 (8.7%)	30 (8.6%)	8 (9.0%)	0.906
Drug abuse	24 (5.5%)	18 (5.2%)	6 (6.7%)	0.601
Type 2 diabetes mellitus	88 (20.1%)	73 (20.9%)	15 (16.9%)	0.393
IDDM	51 (11.6%)	41 (11.7%)	10 (11.2%)	0.893
Immunosuppressive therapy	13 (3.0%)	7 (2.0%)	6 (6.7%)	0.030
Acute renal insufficiency	55 (12.6%)	35 (10.0%)	20 (22.5%)	0.002
Acute dialysis preoperative	27 (6.2%)	16 (4.6%)	11 (12.4%)	0.006
Chronic dialysis preoperative	19 (4.3%)	15 (4.3%)	4 (4.5%)	1.000
Chronic renal insufficiency	123 (28.1%)	101 (28.9%)	22 (24.7%)	0.429
NYHA stages	2 (2; 3)	2 (2; 3)	2 (2; 3)	0.340
NYHA IV	88 (20.2%)	71 (20.5%)	17 (19.1%)	0.785
Coronary heart disease	186 (42.5%)	151 (43.3%)	35 (39.3%)	0.502
State after PCI	39 (8.9%)	31 (8.9%)	8 (9.0%)	0.975
Previous cardiac surgery	181 (41.3%)	157 (45.0%)	24 (27.0%)	0.002
CABG	11 (2.6%)	10 (3.0%)	1 (1.2%)	0.474
Aortic valve replacement	70 (16.7%)	57 (17.1%)	13 (15.1%)	0.665
Mitral valve replacement/reconstruction	8 (1.9%)	7 (2.1%)	1 (1.2%)	1.000
Combined valve surgery	84 (20.0%)	76 (22.8%)	8 (9.3%)	0.005
TAVI	2 (0.5%)	2 (0.6%)	0 (0.0%)	1.000
Tumor	55 (12.6%)	41 (11.7%)	14 (15.7%)	0.311

(b)
	All patients (n = 438)	No neurological complications preoperative (n = 349, 79.7%)	Neurological complications preoperative (n = 89, 20.3%)	value

Acute myocardial infarction (≤48 h)	14 (3.2%)	8 (2.3%)	6 (6.8%)	0.042
Cardiogenic shock	21 (4.8%)	19 (5.4%)	2 (2.2%)	0.274
CPR (≤48 h)	9 (2.1%)	8 (2.3%)	1 (1.1%)	0.694
Inotropic therapy	84 (19.2%)	61 (17.5%)	23 (25.8%)	0.074
Emergency	96 (21.9%)	74 (21.2%)	22 (24.7%)	0.474
Intensive care patient	96 (21.9%)	64 (18.3%)	32 (36.0%)	<0.001
Intubated at admission	38 (8.7%)	27 (7.7%)	11 (12.4%)	0.167
Neurological complications	85 (19.4%)	0 (0.0%)	85 (95.5%)	<0.001
Stroke	78 (17.8%)	0 (0.0%)	78 (87.6%)	<0.001
TIA	7 (1.6%)	0 (0.0%)	7 (7.9%)	<0.001
Silent cerebral embolization	4 (0.9%)	0 (0.0%)	4 (4.5%)	0.841
Preoperative embolization	123 (28.1%)	41 (11.7%)	82 (92.1%)	<0.001
Cerebral	61 (13.9%)	0 (0.0%)	61 (68.5%)	<0.001
Spleen	17 (3.9%)	17 (4.9%)	0 (0.0%)	0.030
Several organs	34 (7.8%)	14 (4.0%)	20 (22.5%)	<0.001
Fever (≥38°C) before surgery	88 (20.1%)	72 (20.6%)	16 (18.0%)	0.577
Tumor	55 (12.6%)	41 (11.7%)	14 (15.7%)	0.311
Endocarditis experienced	63 (14.4%)	58 (16.6%)	5 (5.6%)	0.008
Time from diagnosis to surgery (days)	7 (2; 17)	8 (2; 17)	7 (3; 17)	0.851
Time from antibiotic start to surgery (days)	10 (3; 21)	10 (3; 21)	9 (4; 18)	0.826

(c)
	All patients (n = 438)	No neurological complications preoperative (n = 349, 79.7%)	Neurological complications preoperative (n = 89, 20.3%)	value

Pathogens
Staphylococcus aureus	87 (20.0%)	56 (16.1%)	31 (35.2%)	<0.001
Enterococcus	64 (14.7%)	56 (16.1%)	8 (9.0%)	0.089
Viridans streptococci	47 (10.8%)	40 (11.5%)	7 (7.9%)	0.320
Gram-positive streptococcus	39 (8.9%)	30 (8.6%)	9 (10.1%)	0.665
HACEK group	1 (0.2%)	1 (0.3%)	0 (0.0%)	0.612
Mycosis	6 (1.4%)	5 (1.4%)	1 (1.1%)	1.000
Culture negative	117 (26.8%)	94 (27.1%)	23 (25.8%)	0.813
Staphylococcus epidermidis	30 (6.9%)	26 (7.5%)	4 (4.5%)	0.319
MRSA	15 (3.4%)	10 (2.9%)	5 (5.6%)	0.201
Unknown	44 (10.1%)	38 (11.0%)	6 (6.7%)	0.240
Valve affection
Number of affected valves	1 (1–3)	1 (1–3)	1 (1-2)	0.262
AV isolated	132 (30.1%)	102 (29.2%)	30 (33.7%)	0.411
AV combined	178 (40.6%)	138 (39.5%)	40 (44.9%)	0.354
AV + MV	38 (8.7%)	30 (8.6%)	8 (9.0%)	0.906
MV isolated	99 (22.6%)	69 (19.8%)	30 (33.7%)	0.005
MV + TV	2 (0.5%)	0 (0.0%)	2 (2.2%)	0.041
MV combined	137 (31.3%)	98 (28.1%)	39 (43.8%)	0.004
AV + TV	5 (1.1%)	4 (1.1%)	1 (1.1%)	1.000
AV + TV + MV	2 (0.5%)	2 (0.6%)	0 (0.0%)	1.000
TV isolated	9 (2.1%)	9 (2.6%)	0 (0.0%)	0.215
TV combined	18 (4.1%)	15 (4.3%)	3 (3.4%)	1.000
Prosthetic endocarditis isolated	149 (34.0%)	131 (37.5%)	18 (20.2%)	0.002
Prosthetic endocarditis combined	166 (37.9%)	144 (41.3%)	22 (24.7%)	0.004
TAVI	1 (0.2%)	1 (0.3%)	0 (0.0%)	1.000
Prosthetic endocarditis isolated	71 (16.2%)	61 (17.5%)	10 (11.2%)	0.154
Abscess	121 (27.6%)	101 (28.9%)	20 (22.5%)	0.223
Vegetation	315 (72.7%)	240 (69.8%)	75 (84.3%)	0.006
Vegetation size (mm)	13 (9; 19)	13 (8; 19)	15 (10; 20)	0.128

(d)
	All patients (n = 438)	No neurological complications preoperative (n = 349, 79.7%)	Neurological complications preoperative (n = 89, 20.3%)	value

Hemoglobin (g/dL)	10.3 (9.2; 11.7)	10.3 (9.2; 11.8)	10.0 (8.7; 11.5)	0.066
Hematocrit (%)	30.8 (27.6; 35.0)	31.0 (28.0; 35.0)	29.2 (26.7; 34.0)	0.007
Lactate (mmol/L)	0.8 (0.6; 1.1)	0.8 (0.6; 1.2)	0.7 (0.5; 0.9)	0.006
Potassium (mmol/L)	3.9 (3.6; 4.3)	3.9 (3.6; 4.3)	4.9 (4.5; 5.4)	0.768
CRP (mg/L)	40.9 (15.8; 86.8)	39.7 (16.5; 82.4)	47.5 (13.6; 94.2)	0.539
PCT (ng/mL)	0.24 (0.11; 0.67)	0.21 (0.10; 0.65)	0.28 (0.14; 0.83)	0.375
Creatinine (µmol/L)	102 (76; 143)	103 (77; 141)	097 (71; 149)	0.782
GFR (ml/min)	61 (42; 68)	61 (42; 69)	61 (39; 64)	0.802
Leukocytes (10⁹/L)	8.70 (6.64; 11.36)	8.60 (6.64; 11.16)	9.29 (6.61; 12.69)	0.509
Platelets (10⁹/L)	238 (170; 313)	240 (171; 319)	219 (152; 301)	0.104
Urea (mmol/L)	5.8 (4.0; 10.0)	5.8 (3.9; 9.5)	6.0 (4.5; 11.4)	0.318
CK (U/L)	40 (26; 79)	41 (27; 81)	36 (23; 68)	0.143
CK-MB (U/L)	11.6 (7.8; 18.5)	11.5 (7.9; 17.1)	12.4 (7.4; 22.9)	0.793
AST/GOT (U/L)	29.1 (20.5; 48.0)	28.8 (20.0; 49.7)	30.6 (23.0; 42.8)	0.740
ALT/GPT (U/L)	22.1 (13.2; 37.8)	22.0 (13.2; 38.3)	23.0 (12.7; 37.0)	0.638
Bilirubin (µmol/L)	9.4 (6.3; 15.0)	9.7 (6.6; 16.0)	8.0 (4.9; 13.4)	0.037
INR	1.16 (1.07; 1.30)	1.16 (1.06; 1.30)	1.17 (1.10; 1.31)	0.392

EuroSCORE, European System for Cardiac Operative Risk Evaluation; COPD, chronic obstructive pulmonary disease; LVEF, left ventricular ejection fraction; IDDM, insulin-dependent diabetes mellitus; NYHA IV, New York Heart Association heart failure stage IV; CABG, coronary artery bypass grafting; TAVI, transcatheter aortic valve implantation. CPR, cardiopulmonary resuscitation; TIA, transient ischemic attack. HACEK, Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella; MRSA, methicillin-resistant Staphylococcus aureus; AV, aortic valve; MV, mitral valve; TV, tricuspid valve; TAVI, transcatheter aortic valve implantation. CRP, C-reactive protein; GFR, glomerular filtration rate; CK, creatine kinase; INR, international normalized ratio.