Objective Antiphospholipid (aPL) antibodies may activate platelets and contribute to vegetation growth and embolisation in infective endocarditis (IE). We aimed to determine the value of aPL as predictors of embolic events (EE) in IE.
Methods We studied 186 patients with definite IE (Duke-Li criteria, all types of IE) from the Nanc-IE prospective registry (2007–2012) who all had a frozen blood sample and at least one imaging procedure to detect asymptomatic or confirm symptomatic EE. Anticardiolipin (aCL) and anti-β2-glycoprotein I (β2GPI) antibodies (IgG and IgM) were assessed after the end of patients’ inclusion. The relationship between antibodies and the detection of EE after IE diagnosis were studied with Kaplan-Meier and Cox multivariate analyses.
Results At least one EE was detected in 118 (63%) patients (52 cerebral, 95 other locations) after IE diagnosis in 80 (time interval between IE and EE diagnosis: 5.9±11.3 days). At least one aPL antibody was found in 31 patients (17%).
Detection of EE over time after IE diagnosis was more frequent among patients with anti-β2GPI IgM (log-rank P=0.0036) and that of cerebral embolisms, among patients with aCL IgM and anti-β2GPI IgM (log-rank P=0.002 and P<0.0001, respectively).
Factors predictive of EE were anti-β2GPI IgM (HR=3.45 (1.47–8.08), P=0.0045), creatinine (2.74 (1.55–4.84), P=0.0005) and vegetation size (2.41 (1.41–4.12), P=0.0014). Those of cerebral embolism were aCL IgM (2.84 (1.22–6.62), P=0.016) and anti-β2GPI IgM (4.77 (1.79–12.74), P=0.0018).
Conclusion The presence of aCL and anti-β2GPI IgM was associated with EE, particularly cerebral ones, and could contribute to assess the embolic risk of IE.
- neurologic events
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Contributors CSS, FA, TDL, TL and MLE planned the study. CHM, JD, FG, MLE and CSS conducted the study. CHM, CSS, CT, OH, CV, YJ, TDL, TL, FA and MLE reported the study. CSS, CHM, TDL, CT, OH, CV, YJ and the whole Endocarditis Team of Nancy provided and cared for study patients. MLE supervised the statistical analysis. The Endocarditis Team of Nancy gathers. Infectious diseases: FG, Sandrine Hénard, Elisabeth Baux-Pomares, Caroline Jacquet, TDL (until 2012). Cardiac surgeons: Mazen El Farra, Thierry Folliguet. Microbiologists: Nejla Aissa, Corentine Alauzet. ICU: CT. Research assistants: Catherine Campagnac, Nadine Juge. Statisticians: MLE. Methodologist: FA. They all provided and cared for study patients, and managed Nanc-IE registry.
Funding This work was supported by the University Hospital of Nancy (grant CPRC 2009) and the French Ministry of Health (PHRC-I 2013-13087).
Competing interests None declared.
Ethics approval University Hospital of Nancy Ethics Committee (CPP and CCTIRS/CNIL approval).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Access to data can be obtained from the CIC-EC of the University Hospital of Nancy by asking either FA or CSS.
Collaborators Cardiologists: Olivier Huttin, Clément Venner, Christine Selton Suty. Infectious Diseases: François Goehringer, Sandrine Hénard, Elisabeth Baux Pomares, Caroline Jacquet, Thanh Doco Lecompte (until 2012). Cardiac Surgeons: Mazen El Farra, Thierry Folliguet. Microbiologists: Nejla Aissa, Corentine Alauzet. ICU: Carine Thivilier. Research assistants: Catherine Campagnac, Nadine Juge. Statisticians: Marie Line Erpelding. Methodologist: François Alla.