Neurological complications as a predictor of in-hospital mortality in infective endocarditis: 11 years' experience of tertiary center.

BACKGROUND: Infective endocarditis (IE) remains a life-threatening condition with substantial morbidity and mortality despite advances in diagnosis and treatment. Neurological complications (NCs) are common and strongly influence outcomes; therefore, early identification of high-risk patients is essential. This study aimed to determine the prevalence of NCs in IE and to evaluate their impact on in-hospital mortality. METHODS: We retrospectively analyzed 448 patients diagnosed with IE according to the modified Duke criteria between June 2012 and June 2023. Demographic data, echocardiographic findings, microbiological results, and neurological manifestations were recorded. Associations between NCs and in-hospital mortality were assessed using univariate analyses and multivariate logistic regression. RESULTS: Neurological complications occurred in 27% of patients. Ischemic stroke was the most common manifestation (70%), followed by intracranial hemorrhage (20%). Larger and mobile vegetations were more frequent in patients with NCs, and vegetation size was significantly greater in this group. Microbiological profiles were similar between patients with and without NCs. In-hospital mortality was 28% and was significantly higher in patients with NCs (39% vs. 25%). Independent predictors of NCs included large vegetations (≥10 mm), thrombocytopenia, hypertension, and absence of surgery in native-valve IE. Older age, male sex, hemodialysis, thrombocytopenia, and higher NIHSS scores independently predicted in-hospital mortality. CONCLUSION: Neurological complications are frequent in IE and are associated with worse in-hospital outcomes. Vegetation burden and thrombocytopenia identify patients at increased neurological risk, whereas valve location and microbiological etiology appear less informative. Early risk stratification and multidisciplinary management may improve prognosis.