Infective endocarditis is associated with worse outcomes in stroke: A Thailand National Database Study

Katie A  Reid; Raphae S  Barlasm; Mamas A Mamas; Allan B Clark; Chun Shing Kwok; Chun Wai Wong; Kannikar Kongbunkiat; Joao H Bettencourt-Silva; Kittisak  Sawanyawisuth; Narongrit Kasemsap; Somsak  Tiamkao; Phyo K. Myint

doi:10.1111/ijcp.13614

Infective endocarditis is associated with worse outcomes in stroke: A Thailand National Database Study

Katie A Reid, Raphae S Barlasm, Mamas A Mamas, Allan B Clark, Chun Shing Kwok, Chun Wai Wong, Kannikar Kongbunkiat, Joao H Bettencourt-Silva, Kittisak Sawanyawisuth, Narongrit Kasemsap, Somsak Tiamkao, Phyo K. Myint^* (Corresponding Author)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: There is lack of data on the association between infective endocarditis (IE) and outcomes of mortality and complications in 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 hospitalised strokes between 8 January 2003 and 31 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 comorbidities.

RESULTS: A total of 590 115 stroke patients (mean (SD) age = 64.2 ± 13.7 years; ischaemic = 51.7%; haemorrhagic = 32.6%; undetermined = 15.7%) were included, of whom 2129 (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 <.001). Patients with haemorrhagic stroke with IE had poorer outcomes for in-hospital mortality and respiratory failure compared with their counterparts with ischaemic stroke. Propensity score-matched analysis showed similar results.

CONCLUSIONS: Our results suggest that stroke patients with IE 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 IE.

Original language	English
Article number	13614
Pages (from-to)	e13614
Number of pages	8
Journal	International Journal of Clinical Practice
Volume	74
Issue number	11
Early online date	1 Sept 2020
DOIs	https://doi.org/10.1111/ijcp.13614
Publication status	Published - 1 Nov 2020

Bibliographical note

Acknowledgements
We thank the administrative staff of Insurance Schemes who prepared the anonymized dataset
Funding
No project specific funding was obtained for this study. KAR received the Aberdeen Summer Research Scholarship funded by the NHS Grampian Department of Medicine for the Elderly Endowment Funds.

Keywords

stroke
endocarditis
epidemiology
SURGERY
RISK-FACTORS
EVENTS

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This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. https://creativecommons.org/licenses/by-nc/4.0/
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Cite this

Reid, K. A., Barlasm, R. S., Mamas, M. A., Clark, A. B., Kwok, C. S., Wong, C. W., Kongbunkiat, K., Bettencourt-Silva, J. H., Sawanyawisuth, K., Kasemsap, N., Tiamkao, S., & Myint, P. K. (2020). Infective endocarditis is associated with worse outcomes in stroke: A Thailand National Database Study. International Journal of Clinical Practice, 74(11), e13614. Article 13614. https://doi.org/10.1111/ijcp.13614

Reid, KA, Barlasm, RS, Mamas, MA, Clark, AB, Kwok, CS, Wong, CW, Kongbunkiat, K, Bettencourt-Silva, JH, Sawanyawisuth, K, Kasemsap, N, Tiamkao, S & Myint, PK 2020, 'Infective endocarditis is associated with worse outcomes in stroke: A Thailand National Database Study', International Journal of Clinical Practice, vol. 74, no. 11, 13614, pp. e13614. https://doi.org/10.1111/ijcp.13614

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title = "Infective endocarditis is associated with worse outcomes in stroke: A Thailand National Database Study",

abstract = "BACKGROUND: There is lack of data on the association between infective endocarditis (IE) and outcomes of mortality and complications in 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 hospitalised strokes between 8 January 2003 and 31 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 comorbidities.RESULTS: A total of 590 115 stroke patients (mean (SD) age = 64.2 ± 13.7 years; ischaemic = 51.7%; haemorrhagic = 32.6%; undetermined = 15.7%) were included, of whom 2129 (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 <.001). Patients with haemorrhagic stroke with IE had poorer outcomes for in-hospital mortality and respiratory failure compared with their counterparts with ischaemic stroke. Propensity score-matched analysis showed similar results.CONCLUSIONS: Our results suggest that stroke patients with IE 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 IE.",

keywords = "stroke, endocarditis, epidemiology, SURGERY, RISK-FACTORS, EVENTS",

author = "Reid, {Katie A} and Barlasm, {Raphae S} and Mamas, {Mamas A} and Clark, {Allan B} and Kwok, {Chun Shing} and Wong, {Chun Wai} and Kannikar Kongbunkiat and Bettencourt-Silva, {Joao H} and Kittisak Sawanyawisuth and Narongrit Kasemsap and Somsak Tiamkao and Myint, {Phyo K.}",

note = "Acknowledgements We thank the administrative staff of Insurance Schemes who prepared the anonymized dataset Funding No project specific funding was obtained for this study. KAR received the Aberdeen Summer Research Scholarship funded by the NHS Grampian Department of Medicine for the Elderly Endowment Funds.",

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doi = "10.1111/ijcp.13614",

language = "English",

volume = "74",

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T1 - Infective endocarditis is associated with worse outcomes in stroke

T2 - A Thailand National Database Study

AU - Reid, Katie A

AU - Barlasm, Raphae S

AU - Mamas, Mamas A

AU - Clark, Allan B

AU - Kwok, Chun Shing

AU - Wong, Chun Wai

AU - Kongbunkiat, Kannikar

AU - Bettencourt-Silva, Joao H

AU - Sawanyawisuth, Kittisak

AU - Kasemsap, Narongrit

AU - Tiamkao, Somsak

AU - Myint, Phyo K.

N1 - Acknowledgements We thank the administrative staff of Insurance Schemes who prepared the anonymized dataset Funding No project specific funding was obtained for this study. KAR received the Aberdeen Summer Research Scholarship funded by the NHS Grampian Department of Medicine for the Elderly Endowment Funds.

PY - 2020/11/1

Y1 - 2020/11/1

N2 - BACKGROUND: There is lack of data on the association between infective endocarditis (IE) and outcomes of mortality and complications in 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 hospitalised strokes between 8 January 2003 and 31 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 comorbidities.RESULTS: A total of 590 115 stroke patients (mean (SD) age = 64.2 ± 13.7 years; ischaemic = 51.7%; haemorrhagic = 32.6%; undetermined = 15.7%) were included, of whom 2129 (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 <.001). Patients with haemorrhagic stroke with IE had poorer outcomes for in-hospital mortality and respiratory failure compared with their counterparts with ischaemic stroke. Propensity score-matched analysis showed similar results.CONCLUSIONS: Our results suggest that stroke patients with IE 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 IE.

AB - BACKGROUND: There is lack of data on the association between infective endocarditis (IE) and outcomes of mortality and complications in 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 hospitalised strokes between 8 January 2003 and 31 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 comorbidities.RESULTS: A total of 590 115 stroke patients (mean (SD) age = 64.2 ± 13.7 years; ischaemic = 51.7%; haemorrhagic = 32.6%; undetermined = 15.7%) were included, of whom 2129 (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 <.001). Patients with haemorrhagic stroke with IE had poorer outcomes for in-hospital mortality and respiratory failure compared with their counterparts with ischaemic stroke. Propensity score-matched analysis showed similar results.CONCLUSIONS: Our results suggest that stroke patients with IE 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 IE.

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KW - endocarditis

KW - epidemiology

KW - SURGERY

KW - RISK-FACTORS

KW - EVENTS

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Infective endocarditis is associated with worse outcomes in stroke: A Thailand National Database Study

Abstract

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