Abstract Body: Introduction
Neurological complications in patients with infective endocarditis (IE), such as ischemic and hemorrhagic stroke, are well-described, serious complications of IE; however, predicting which patients are most likely to experience stroke remains uncertain. The objective of this systematic review was to identify the factors associated with risk of stroke in patients hospitalized with IE.

Methods:
A systematic search of Ovid MEDLINE, EMBASE, and Web of Science was conducted between January 1990 and to July 2024. Articles evaluating risk of acute ischemic stroke (AIS) and/or intracranial hemorrhage (ICH) in patients with IE were included. Meta-analysis was feasible for only some predictive factors due to study heterogeneity. (PROSPERO protocol CRD42024571058).

Results:
Of 3558 studies identified, 35 were included: The review included 9 prospective and 26 retrospective cohort studies. Staphylococcus aureus infection (odds ratio, 3.05 [95% CI, 1.96-4.73]; I²=77.2%; 9 studies) and 1 mm longer in vegetation size, on average (odds ratio, 1.26 [95% CI, 1.02-1.55]; I²=90.1%; 3 studies) were associated with a higher risk of AIS, adjusting for other covariates. Due to high heterogeneity among the studies, a meta-analysis was not feasible for the other predictive factors. High intensity signals on transcranial doppler, and comorbidities such as hypertension, atrial fibrillation, and hyperlipidemia were also found to have a higher risk of AIS. Risk of ICH was heightened by thrombocytopenia, mycotic aneurysms, prior ICH and/or AIS, and cerebral microbleeds.

Conclusion:
Physicians need to monitor numerous, diverse features of patients hospitalized with IE to mitigate the risk of ensuing stroke. While the causative microorganism, echocardiographic and neuroimaging findings may be particularly informative, underlying comorbidities and various laboratory values may also contribute to predicting IE-associated ischemic and hemorrhagic stroke.