Incidence of infective endocarditis-related stroke linked to rise in IV drug use
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Infective endocarditis-related stroke was increasingly associated with IV drug use and fewer traditional risk factors such as diabetes and hypertension, a trend researchers attributed to recent demographics of the opioid epidemic.
“Ischemic stroke is the most common neurologic complication of infective endocarditis, afflicting 20% to 40% of cases,” Mohamed Ridha, MD, of the University of Cincinnati Medical Center, and colleagues wrote in Neurology. “Early identification of [infective endocarditis-related stroke] is paramount since initiation of antibiotic therapy is effective in reducing further embolization.”
Citing an increasing incidence of infective endocarditis-related stroke (IERS) related to the opioid epidemic in the United States, researchers aimed to review trends in demographics, risk factors and clinical features of IERS.
They conducted a retrospective cohort study and included 54 individuals with IERS and 8,204 without IERS who were identified and physician verified as having either hemorrhagic or ischemic stroke during the 2005, 2010 and 2015 calendar years. All participants were part of the epidemiologic Greater Cincinnati/Northern Kentucky Stroke Study, which is conducted every 5 years and includes all inpatient strokes.
Researchers compared demographics, risk factors and health outcomes between study intervals via chi-square and analyzed the interaction of endocarditis status for those factors using a general linear or logistic model.
Results showed a decline in rates of hypertension (91.7% vs. 36%) and increased IV drug users (8.3% vs. 44%) in the IERS cohort between 2005 and 2015, while those without IERS demonstrated a significant rise in hypertension, diabetes, atrial fibrillation and peri-operative stroke.
Researchers also reported a non-significant trend in the IERS group of increasing proportions of white individuals, younger age and lower proportion of traditional vascular risk factors such as diabetes, heart valve replacement, renal failure and prior stroke. Conversely, in the non-IERS cohort, they noted increased prevalence of Black and male individuals, along with hypertension, diabetes, atrial fibrillation and perioperative stroke.
About one-fifth of patients in the IERS cohort had active infective endocarditis at stroke recognition, and clinical evidence of sepsis was noted in 27.8% of IERS patients. In addition, IV drug users with IERS were men, significantly younger and had no history of atrial fibrillation or end-stage renal disease.
“The poor functional outcomes and mortality have not improved over the decade study period, emphasizing the need for tailored innovation in this pathology,” Ridha and colleagues wrote.