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Clinical Trial
. 2024 Mar 13;11(3):ofae121.
doi: 10.1093/ofid/ofae121. eCollection 2024 Mar.

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

Jorge Calderón-Parra  1   2 , Fernando Domínguez  2   3 , Claudia González-Rico  4 , Francisco Arnaiz de Las Revillas  4 , Miguel Ángel Goenaga  5 , I Alvarez  5 , Patricia Muñoz  6 , David Alonso  6 , Raquel Rodríguez-García  7 , José María Miró  8 , Arístides De Alarcón  9 , Isabel Antorrena  10 , Josune Goikoetxea-Agirre  11 , Encarnación Moral-Escudero  12 , Guillermo Ojeda-Burgos  13 , Antonio Ramos-Martínez  1   2   14 ; Spanish Collaboration on Endocarditis (GAMES)
Collaborators, Affiliations
Clinical Trial

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

Jorge Calderón-Parra et al. Open Forum Infect Dis. .

Abstract

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.

Keywords: complications; epidemiology; infective endocarditis; mortality; mycotic aneurysm.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts.

Figures

Figure 1.
Figure 1.
Survival curve for 1-y mortality, obtained by means of multivariate Cox regression model, including absence of mycotic aneurysm, unruptured mycotic aneurysm, and ruptured mycotic aneurysm. Covariates were age (HR, 1.03 per year; 95% CI, 1.02–1.03), Charlson index (HR, 1.12 per point; 95% CI, 1.11–1.15), community-acquired endocarditis (HR, 0.81; 95% CI, .72–.90), natural valve endocarditis (HR, 1.12; 95% CI, .99–1.25), Streptococcus spp. (HR, 0.63; 95% CI, .55–.73), Candida spp. (HR, 1.41; 95% CI, 1.01–1.97), and valve perforation (HR, 1.17; 95% CI, 1.01–1.37). 95% CI, 95% confidence interval; HR, hazard ratio; MA, mycotic aneurysm.
Figure 2.
Figure 2.
Proposal algorithm for management of mycotic aneurysms in patients with infective endocarditis.
See this image and copyright information in PMC

References

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