Epidemiology and Risk Factors of Mycotic Aneurysm in Patients With Infective Endocarditis and the Impact of its Rupture in Outcomes. Analysis of a National Prospective Cohort
© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America..
Background: Several aspects of the occurrence and management of mycotic aneurysm (MA) in patients with infective endocarditis (IE) have not been studied.
Objectives: To determine the incidence and factors associated with MA presence and rupture and to assess the evolution of those initially unruptured MA.
Methods: Prospective multicenter cohort including all patients with definite IE between January 2008 and December 2020.
Results: Of 4548 IE cases, 85 (1.9%) developed MA. Forty-six (54.1%) had intracranial MA and 39 (45.9%) extracranial MA. Rupture of MA occurred in 39 patients (45.9%). Patients with ruptured MA had higher 1-year mortality (hazard ratio, 2.33; 95% confidence interval, 1.49-3.67). Of the 55 patients with initially unruptured MA, 9 (16.4%) presented rupture after a median of 3 days (interquartile range, 1-7) after diagnosis, being more frequent in intracranial MA (32% vs 3.3%, P = .004). Of patients with initially unruptured MA, there was a trend toward better outcomes among those who received early specific intervention, including lower follow-up rupture (7.1% vs 25.0%, P = .170), higher rate of aneurysm resolution in control imaging (66.7% vs 31.3%, P = .087), lower MA-related mortality (7.1% vs 16.7%, P = .232), and lower MA-related sequalae (0% vs 27.8%, P = .045).
Conclusions: MA occurred in 2% of the patients with IE. Half of the Mas occurred in an intracranial location. Their rupture is frequent and associated with poor prognosis. A significant proportion of initially unruptured aneurysms result from rupture during the first several days, being more common in intracranial aneurysms. Early specific treatment could potentially lead to better outcomes.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
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| Enthalten in: |
Open forum infectious diseases - 11(2024), 3 vom: 19. März, Seite ofae121 |
| Sprache: |
Englisch |
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| Links: |
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| Themen: |
Clinical Trial |
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| Anmerkungen: |
Date Revised 29.03.2024 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1093/ofid/ofae121 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369902203 |
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| 100 | 1 | |a Calderón-Parra, Jorge |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Epidemiology and Risk Factors of Mycotic Aneurysm in Patients With Infective Endocarditis and the Impact of its Rupture in Outcomes. Analysis of a National Prospective Cohort |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 29.03.2024 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. | ||
| 520 | |a Background: Several aspects of the occurrence and management of mycotic aneurysm (MA) in patients with infective endocarditis (IE) have not been studied | ||
| 520 | |a Objectives: To determine the incidence and factors associated with MA presence and rupture and to assess the evolution of those initially unruptured MA | ||
| 520 | |a Methods: Prospective multicenter cohort including all patients with definite IE between January 2008 and December 2020 | ||
| 520 | |a Results: Of 4548 IE cases, 85 (1.9%) developed MA. Forty-six (54.1%) had intracranial MA and 39 (45.9%) extracranial MA. Rupture of MA occurred in 39 patients (45.9%). Patients with ruptured MA had higher 1-year mortality (hazard ratio, 2.33; 95% confidence interval, 1.49-3.67). Of the 55 patients with initially unruptured MA, 9 (16.4%) presented rupture after a median of 3 days (interquartile range, 1-7) after diagnosis, being more frequent in intracranial MA (32% vs 3.3%, P = .004). Of patients with initially unruptured MA, there was a trend toward better outcomes among those who received early specific intervention, including lower follow-up rupture (7.1% vs 25.0%, P = .170), higher rate of aneurysm resolution in control imaging (66.7% vs 31.3%, P = .087), lower MA-related mortality (7.1% vs 16.7%, P = .232), and lower MA-related sequalae (0% vs 27.8%, P = .045) | ||
| 520 | |a Conclusions: MA occurred in 2% of the patients with IE. Half of the Mas occurred in an intracranial location. Their rupture is frequent and associated with poor prognosis. A significant proportion of initially unruptured aneurysms result from rupture during the first several days, being more common in intracranial aneurysms. Early specific treatment could potentially lead to better outcomes | ||
| 650 | 4 | |a Clinical Trial | |
| 650 | 4 | |a complications | |
| 650 | 4 | |a epidemiology | |
| 650 | 4 | |a infective endocarditis | |
| 650 | 4 | |a mortality | |
| 650 | 4 | |a mycotic aneurysm | |
| 700 | 1 | |a Domínguez, Fernando |e verfasserin |4 aut | |
| 700 | 1 | |a González-Rico, Claudia |e verfasserin |4 aut | |
| 700 | 1 | |a Arnaiz de Las Revillas, Francisco |e verfasserin |4 aut | |
| 700 | 1 | |a Goenaga, Miguel Ángel |e verfasserin |4 aut | |
| 700 | 1 | |a Alvarez, I |e verfasserin |4 aut | |
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| 700 | 1 | |a Rodríguez-García, Raquel |e verfasserin |4 aut | |
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| 700 | 1 | |a De Alarcón, Arístides |e verfasserin |4 aut | |
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| 700 | 1 | |a Goikoetxea-Agirre, Josune |e verfasserin |4 aut | |
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| 700 | 1 | |a Ramos-Martínez, Antonio |e verfasserin |4 aut | |
| 700 | 0 | |a Spanish Collaboration on Endocarditis (GAMES) |e verfasserin |4 aut | |
| 700 | 1 | |a Sánchez, Fernando Fernández |e investigator |4 oth | |
| 700 | 1 | |a de Lomas, José Mª García |e investigator |4 oth | |
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| 700 | 1 | |a de la Torre Lima, Javier |e investigator |4 oth | |
| 700 | 1 | |a Bereciartua, Elena |e investigator |4 oth | |
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| 700 | 1 | |a Boado, María Victoria |e investigator |4 oth | |
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| 700 | 1 | |a Carrión, Laura Guio |e investigator |4 oth | |
| 700 | 1 | |a de Lagos, Mikel Del Álamo Martínez |e investigator |4 oth | |
| 700 | 1 | |a Ugarte, Gorane Euba |e investigator |4 oth | |
| 700 | 1 | |a Goikoetxea, Ane Josune |e investigator |4 oth | |
| 700 | 1 | |a Hierro, Marta Ibarrola |e investigator |4 oth | |
| 700 | 1 | |a Iruretagoyena, José Ramón |e investigator |4 oth | |
| 700 | 1 | |a Zuazabal, Josu Irurzun |e investigator |4 oth | |
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| 700 | 1 | |a Nieto, Javier |e investigator |4 oth | |
| 700 | 1 | |a Rodrigo, David |e investigator |4 oth | |
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| 700 | 1 | |a Voces, Roberto |e investigator |4 oth | |
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| 700 | 1 | |a Bailón, Isabel Rodríguez |e investigator |4 oth | |
| 700 | 1 | |a Morales, Josefa Ruiz |e investigator |4 oth | |
| 700 | 1 | |a Rodríguez, Ignacio Álvarez |e investigator |4 oth | |
| 700 | 1 | |a Galparsoro, Harkaitz Azkune |e investigator |4 oth | |
| 700 | 1 | |a Boronat, Elisa Berritu |e investigator |4 oth | |
| 700 | 1 | |a Odriozola, Mª Jesús Bustinduy |e investigator |4 oth | |
| 700 | 1 | |a Martín, Cristina Del Bosque |e investigator |4 oth | |
| 700 | 1 | |a Echeverría, Tomás |e investigator |4 oth | |
| 700 | 1 | |a Yarza, Alberto Eizaguirre |e investigator |4 oth | |
| 700 | 1 | |a Fuentes, Ana |e investigator |4 oth | |
| 700 | 1 | |a Goenaga, Miguel Ángel |e investigator |4 oth | |
| 700 | 1 | |a Del Río, Muskilda Goyeneche |e investigator |4 oth | |
| 700 | 1 | |a Bauza, Ángela Granda |e investigator |4 oth | |
| 700 | 1 | |a Iribarren, José Antonio |e investigator |4 oth | |
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| 700 | 1 | |a Jiménez, Ainhoa Rengel |e investigator |4 oth | |
| 700 | 1 | |a Reviejo, Karlos |e investigator |4 oth | |
| 700 | 1 | |a Berbejillo, Alberto Sáez |e investigator |4 oth | |
| 700 | 1 | |a Haza, Elou Sánchez |e investigator |4 oth | |
| 700 | 1 | |a Alda, Rosa Sebastián |e investigator |4 oth | |
| 700 | 1 | |a Ruiz, Itziar Solla |e investigator |4 oth | |
| 700 | 1 | |a Ugartemendia, Irati Unamuno |e investigator |4 oth | |
| 700 | 1 | |a Anza, Diego Vicente |e investigator |4 oth | |
| 700 | 1 | |a Benito, Iñaki Villanueva |e investigator |4 oth | |
| 700 | 1 | |a Arrieta, Mar Zabalo |e investigator |4 oth | |
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| 700 | 1 | |a Bouzas, Alberto |e investigator |4 oth | |
| 700 | 1 | |a Castelo, Brais |e investigator |4 oth | |
| 700 | 1 | |a Cuenca, José |e investigator |4 oth | |
| 700 | 1 | |a Gutiérrez, Laura |e investigator |4 oth | |
| 700 | 1 | |a Ramos, Lucía |e investigator |4 oth | |
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| 700 | 1 | |a Serrano, Joaquín Manuel |e investigator |4 oth | |
| 700 | 1 | |a Regueiro, Dolores Sousa |e investigator |4 oth | |
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| 700 | 1 | |a Castro, Beatriz |e investigator |4 oth | |
| 700 | 1 | |a Melian, Teresa Delgado |e investigator |4 oth | |
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| 700 | 1 | |a Rosado, Dácil García |e investigator |4 oth | |
| 700 | 1 | |a González, Julia González |e investigator |4 oth | |
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