{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T10:50:46Z","timestamp":1771066246666,"version":"3.50.1"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T00:00:00Z","timestamp":1655424000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T00:00:00Z","timestamp":1655424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Infective endocarditis still has high mortality and invalidating complications, such as cerebral embolism. The best strategies to prevent and manage neurologic complications remain uncertain. This study aimed to identify predictors of cerebral septic embolism and evaluate the role of surgery in these patients in a real-world surgical centre.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We retrospectively analyzed 551 consecutive patients admitted to our department with a definite diagnosis of non-device-related infective endocarditis; of these, 126 (23%) presented a neurologic complication.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Cerebral embolism was significantly more frequent in patients with large vegetations (p\u2009=\u20090.004), mitral valve infection (p\u2009=\u20090.001), and Staphylococcus aureus infection (p\u2009=\u20090.025). At multivariable analysis, only vegetation length was an independent predictor of cerebral embolism (HR per unit 1.057, 95% CI 1.025\u20131.091, p 0.001), with a best predictive threshold of 10\u00a0mm at ROC curve analysis (AUC 0.54, p\u2009=\u20090.001). Patients with neurologic complications were more often excluded from surgery despite an indication to it (16% vs 8%, p\u2009=\u20090.001). If eligible, they were treated within two weeks from diagnosis in similar proportions as patients without cerebral embolism with a similar survival rate. Predictors of mortality were hemorrhagic lesions (p\u2009=\u20090.018), a GCS\u2009&lt;\u200914 (p\u2009=\u20090.001) or a severe degree of disability (p\u2009=\u20090.001) at presentation. The latter was the only independent predictor of mortality at multivariable analysis (HR 2.3, 95% CI 1.43\u20133.80, p\u2009=\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The present study highlights the prognostic value of functional presentation and the safety of cardiac surgery, when feasible, in patients with cerebral septic embolism.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-022-07533-w","type":"journal-article","created":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T14:09:13Z","timestamp":1655474953000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Impact of septic cerebral embolism on prognosis and therapeutic strategies of infective endocarditis: a retrospective study in a surgical centre"],"prefix":"10.1186","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8182-7074","authenticated-orcid":false,"given":"Valentina","family":"Scheggi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Menale","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Tonietti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Costanza","family":"Bigiarini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacopo","family":"Giovacchini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Del Pace","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Zoppetti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Alterini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pier Luigi","family":"Stef\u00e0no","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niccol\u00f2","family":"Marchionni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,6,17]]},"reference":[{"issue":"5","key":"7533_CR1","first-page":"508","volume":"17","author":"D Gabbieri","year":"2008","unstructured":"Gabbieri D, Dohmen PM, Linneweber J, Grubitzsch H, von Heymann C, Neumann K, et al. Early outcome after surgery for active native and prosthetic aortic valve endocarditis. J Heart Valve Dis. 2008;17(5):508.","journal-title":"J Heart Valve Dis"},{"key":"7533_CR2","first-page":"22","volume":"18","author":"PM Dohmen","year":"2016","unstructured":"Dohmen PM, Binner C, Mende M, Daviewala P, Etz CD, Borger MA, et al. Gender-based long-term surgical outcome in patients with active infective aortic valve endocarditis. Med Sci Monit. 2016;18:22.","journal-title":"Med Sci Monit"},{"issue":"1","key":"7533_CR3","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1093\/icvts\/ivr010","volume":"14","author":"M Rossi","year":"2012","unstructured":"Rossi M, Gallo A, De Silva RJ, Sayeed R. What is the optimal timing for surgery in infective endocarditis with cerebrovascular complications? Interact Cardiovasc Thorac Surg. 2012;14(1):72\u201380.","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"7533_CR4","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1093\/eurheartj\/ehv319","volume":"36","author":"G Habib","year":"2015","unstructured":"Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta J-P, Del Zotti F, et al. ESC Scientific Document Group, 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) En-dorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). 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Br J Nurs. 1992;1(7):325\u20139.","journal-title":"Br J Nurs"},{"issue":"1","key":"7533_CR7","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s12872-021-01853-6","volume":"21","author":"V Scheggi","year":"2021","unstructured":"Scheggi V, Merilli I, Marcucci R, Del Pace S, Olivotto I, Zoppetti N, Ceschia N, Andrei V, Alterini B, Stef\u00e0no PL, Marchionni N. Predictors of mortality and adverse events in patients with infective endocarditis: a retrospective real world study in a surgical centre. BMC Cardiovasc Disord. 2021;21(1):28.","journal-title":"BMC Cardiovasc Disord"},{"issue":"14","key":"7533_CR8","doi-asserted-by":"publisher","first-page":"1745","DOI":"10.1161\/01.CIR.0000124719.61827.7F","volume":"109","author":"VH Chu","year":"2004","unstructured":"Chu VH, Cabell CH, Benjamin DK Jr, Kuniholm EF, Fowler VG Jr, Engemann J, Sexton DJ, Corey GR, Wang A. Early predictors of in-hospital death in infective endocarditis. 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Stroke. 2006;37(8):2094\u20139.","journal-title":"Stroke"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-022-07533-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-022-07533-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-022-07533-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T14:10:19Z","timestamp":1655475019000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-022-07533-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,17]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["7533"],"URL":"https:\/\/doi.org\/10.1186\/s12879-022-07533-w","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,17]]},"assertion":[{"value":"31 March 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 June 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 June 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the local ethics Committee (Regional Ethics Committee of Tuscany for Experimental Medicine, Section: AREA VASTA CENTRO, n 12113_oss), that, in keeping with statements by the Italian Regulatory Authorities for retrospective, observational studies (), granted a waiver of informed consent from study participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"554"}}