Brain imaging determinants of functional prognosis after severe endocarditis: a multicenter observational study.
Neurol Sci. 2022-01-29; 43(6): 3759-3768
DOI: 10.1007/s10072-021-05789-9
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Guettard YO(#)(1), Gros A(#)(2), Fukutomi H(3), Pillois X(4), Préau S(5), Lavie-Badie Y(6), Marest D(7), Martins RP(8), Coupez E(9), Coudroy R(10)(11), Seguy B(12), Boyer A(2), Tourdias T(13)(14); ICE-COCA investigators.
Collaborators: Gruson D, Coste P, Souweine B, Nseir S, Toussaint A, Outteryck O,
Reignier J, Robert R, Urien JM, Porte L, Robin G, Charbonnier G, Sarton B, Silva
S.
Author information:
(1)Service de Neuroradiologie, CHU de Bordeaux, 33000, Bordeaux, France.
(2)Service de Médecine Intensive Réanimation, CHU de Bordeaux, 33000, Bordeaux,
France.
(3)INSERM-U1215, Neurocentre Magendie, 33000, Bordeaux, France.
(4)Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, 33000, Bordeaux,
France.
(5)Réanimation Médicale, CHU de Lille, 59000, Lille, France.
(6)Centre Expert de La Valve, Fédération de Cardiologie, CHU de Toulouse, 31000,
Toulouse, France.
(7)Service d’Anesthésie-Réanimation, Hôpital Laënnec, CHU de Nantes, 44000,
Nantes, France.
(8)Cardiologie Et Maladies Vasculaires, CHU de Rennes, 35000, Rennes, France.
(9)Réanimation Médicale Polyvalente, CHU de Clermont-Ferrand, 63000,
Clermont-Ferrand, France.
(10)Médecine Intensive Réanimation, CHU de Poitiers, 86000, Poitiers, France.
(11)INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, 86000, Poitiers,
France.
(12)Soins Intensifs de Cardiologie, Hôpital Cardiologique du Haut-Lévêque, CHU
de Bordeaux, 33000, Bordeaux, France.
(13)Service de Neuroradiologie, CHU de Bordeaux, 33000, Bordeaux, France.
.
(14)INSERM-U1215, Neurocentre Magendie, 33000, Bordeaux, France.
.
(#)Contributed equally
OBJECTIVE: We developed a detailed imaging phenotype of the cerebral
complications in critically ill patients with infective endocarditis (IE) and
determine whether any specific imaging pattern could impact prognostic
information.
METHODS: One hundred ninety-two patients admitted to the intensive care units of
seven tertiary centers with severe, definite left IE and neurological
complications were included. All underwent cerebral imaging few days after
admission to define the types of lesions, their volumes, and their locations
using voxel-based lesion-symptom mapping (VLSM). We employed uni- and
multi-variate logistic regression analyses to explore the associations among
imaging features and other prognostic variables and the 6-month modified Rankin
Scale (mRS) score.
RESULTS: Ischemic lesions were the most common lesions (75%; mean volume,
15.3 ± 33 mL) followed by microbleeds (50%; mean number, 4 ± 7.5),
subarachnoidal hemorrhages (20%), hemorrhagic strokes (16%; mean volume,
14.6 ± 21 mL), and hemorrhagic transformations (10%; mean volume, 5.6 ± 11 mL).
The volume of hemorrhagic transformations, the severity of leukopathy, and the
compromises of certain locations on the motor pathway from the VLSM were
associated with a poor 6-month mRS score on univariate analyses. However, upon
multivariate analyses, no such specific imaging pattern independently predicted
the mRS; this was instead influenced principally by age (OR = 1.03 [1.004-1.06])
and cardiac surgery status (OR = 0.06 [0.02-0.16]) in the entire cohort, and by
age (OR = 1.04 [1.01-1.08]) and Staphylococcus aureus status (OR = 2.86
[1.19-6.89]) in operated patients.
CONCLUSIONS: In a cohort of severely ill IE patients with neurological
complications, no specific imaging pattern could be highlighted as a reliable
predictor of prognosis.
© 2021. Fondazione Società Italiana di Neurologia.