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Master Thesis

Évaluation du pronostic fonctionnel après une endocardite infectieuse grave avec complications neurologiques : apport de l'imagerie

Abstract : Purpose: to provide an imaging phenotype of the cerebral complications in critically-ill patients with IE and to look whether a specific pattern could convey prognosis information. Methods: 192 patients admitted in intensive care unit for a severe definite left IE with neurological complications were included from 7 tertiary centers. All of them were explored with cerebral imaging (MRI or CT) at admission to quantify the types of lesions, their volumes and their locations by using voxel-based lesion-symptom mapping (VLSM). We used uni- and multivariate logistic regression to study the influence of imaging features together with the other prognostic variables on the 6 month modified Rankin scale (mRS) in the all cohort and in patients who underwent cardiac surgery. Results: ischemic lesions were the most frequent findings (75%, mean volume 15.3±33ml) followed by microbleed (50%, mean number 4±7.5), subarchnoidal hemorrhage (20%), hemorrhagic stroke (16%) and hemorrhagic transformation (10%). Higher volume of hemorrhagic transformation, higher leucopathy and involvement of specific locations comprising the motor pathway from VLSM were associated with the worst 6 month mRS in univariate analyses. In multivariate analyses, no such specific imaging pattern persisted as independent predictor of mRS that was mainly driven by age (OR=1.03 [1.004-1.06], P=0.023) and cardiac surgery (OR=0.06 [0.02, 0.16], P<0.001) in the all cohort, and by age (OR=1.04 [1.01-1.08], P=0.015) and Staphylococcus Aureus germ (OR=2.86 [1.19-6.89], P=0.02) in operated patients. Conclusions: in a cohort of severely ill IE patients with neurological complications in all of them, a specific imaging pattern could not be highlighted as more pejorative than another.
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Submitted on : Wednesday, October 21, 2020 - 6:40:50 PM
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Yves-Olivier Guettard. Évaluation du pronostic fonctionnel après une endocardite infectieuse grave avec complications neurologiques : apport de l'imagerie. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02974449⟩

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