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Detection of spleen, kidney and liver infarcts by abdominal computed tomography does not affect the outcome in patients with left-side infective endocarditis.

Abstract：

:Extra-cardiac abdominal complications are common in left-side infective endocarditis (LS-IE). The aim of this work was to study whether patients with LS-IE presenting splenic, renal, or liver (SRL) involvement seen in abdominal computed tomography (CT) had different clinical features, therapeutic plans, and outcome than those without these findings on CT.From January 2008 to April 2010, multidisciplinary teams have prospectively collected all consecutive cases of IE, diagnosed according to the Duke criteria, in which abdominal CT was performed.A total of 147 patients with LS-IE had abdominal CT. Fifty (34%) had SRL lesions: 46 splenic, 15 renal, 1 liver infarct, and 2 liver abscesses. Patients with SRL lesions were mainly men (P = .01), had liver disease (P = .001) with natural valve (P = .050) and mitro-aortic valve involvement (P = .042), splenomegaly (P = .001), nonabdominal emboli (P = .001), and a greater number and larger vegetation (>15 mm, P = .049) in the mitro-aortic valves (P = .051) than patients with normal abdominal CT. The site of acquisition, clinical characteristics, microbiology, surgical treatment, days of hospitalization, hospital death, and 1-year mortality were similar in patients with and without SRL emboli on CT. In the stepwise logistic regression analysis, male gender (odds ratio [OR] = 3.6, 95% confidence interval [CI] = 1.4-9.1), liver disease (OR = 8.3, 95% CI = 2.1-31.8), and nonabdominal emboli (OR = 5.2, 95% CI = 2.3-11.7) were independently associated with SRL lesions.Male patients with native LS-IE who had liver disease and nonabdominal emboli had more frequent abdominal lesions seen on CT. The presence of SRL infarcts on abdominal CT scan performed on patients with LS-IE seems to have poor practical implications, and as a consequence, its realization should only be considered when there are symptoms or signs that suggest them.

journal_name

Medicine (Baltimore)

journal_title

Medicine

authors

Parra JA,Hernández L,Muñoz P,Blanco G,Rodríguez-Álvarez R,Vilar DR,de Alarcón A,Goenaga MA,Moreno M,Fariñas MC,Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES).

doi

10.1097/MD.0000000000011952

subject

Has Abstract

pub_date

2018-08-01 00:00:00

pages

e11952

issue

eissn

0025-7974

issn

1536-5964

pii

00005792-201808170-00051

journal_volume

pub_type

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Detection of spleen, kidney and liver infarcts by abdominal computed tomography does not affect the outcome in patients with left-side infective endocarditis.