Florent Von Tokarski1, Adrien Lemaignen2, Antoine Portais3, Laurent Fauchier4, Fanny Hennekinne5, Bénédicte Sautenet6, Jean-Michel Halimi6, Annick Legras7, Frédéric Patat8, Thierry Bourguignon9, Christian Mirguet10, Anne Bernard4, Louis Bernard3. 1. Service de Médecine interne et Maladies Infectieuses, France; Service de Néphrologie-HTA, Dialyses, Transplantation Rénale, France. 2. Service de Médecine interne et Maladies Infectieuses, France. Electronic address: adrien.lemaignen@univ-tours.fr. 3. Service de Médecine interne et Maladies Infectieuses, France. 4. Service de Cardiologie, France. 5. Service de Gériatrie, France. 6. Service de Néphrologie-HTA, Dialyses, Transplantation Rénale, France. 7. Service de Médecine Intensive, France. 8. Service d'échographie, France. 9. Service de chirurgie cardio-vasculaire, France. 10. Service de réanimation cardio-vasculaire, CHRU de Tours, Tours, France.
Abstract
OBJECTIVES: The incidence of acute kidney injury (AKI) in infective endocarditis (IE), its risk factors and consequences on patient and renal survival remain debated. METHODS: Patients hospitalized for a first episode of IE (possible or definite according to modified Duke criteria) between 2013 and 2016 were included. The primary endpoint was to determine risk factors for early AKI (E-AKI) during the first week of management of IE. RESULTS: A total of 276 patients were included: 220 (79.7%) had definite IE and 56 (20.3%) had possible IE. E-AKI occurred in 150 patients (53%). IE due to Staphylococcus aureus (OR 3.41; 95% CI 1.83-6.39; p<0.01), history of diabetes (OR 2.34; 95% CI 1.25-4.37; p<0.01), peripheral arterial disease (OR 2.59; 95% CI 1.07-6.23; p<0.05), immunological manifestations (OR 3.11; 95% CI 1.31-7.39; p=0.01), and use of norepinephrine (OR 3.44; 95% CI 1.72-7.02; p<0.01) were associated with E-AKI. In subgroup analysis, infectious disease consultation was associated with a lower risk of AKI at day 7 (OR 0.41; 95% CI 0.16-0.88; p=0.04). E-AKI was associated with 1-year mortality (OR 1.65; 95% CI 1.03-2.64; p=0.04) and chronic kidney disease progression (OR 2.23; 95% CI 1.30-3.82; p<0.01). CONCLUSIONS: E-AKI is common in IE and often associated with non-modifiable variables. Multidisciplinary management should be mandatory, and awareness of AKI diagnosis and etiological explorations should be raised.
OBJECTIVES: The incidence of acute kidney injury (AKI) in infective endocarditis (IE), its risk factors and consequences on patient and renal survival remain debated. METHODS:Patients hospitalized for a first episode of IE (possible or definite according to modified Duke criteria) between 2013 and 2016 were included. The primary endpoint was to determine risk factors for early AKI (E-AKI) during the first week of management of IE. RESULTS: A total of 276 patients were included: 220 (79.7%) had definite IE and 56 (20.3%) had possible IE. E-AKI occurred in 150 patients (53%). IE due to Staphylococcus aureus (OR 3.41; 95% CI 1.83-6.39; p<0.01), history of diabetes (OR 2.34; 95% CI 1.25-4.37; p<0.01), peripheral arterial disease (OR 2.59; 95% CI 1.07-6.23; p<0.05), immunological manifestations (OR 3.11; 95% CI 1.31-7.39; p=0.01), and use of norepinephrine (OR 3.44; 95% CI 1.72-7.02; p<0.01) were associated with E-AKI. In subgroup analysis, infectious disease consultation was associated with a lower risk of AKI at day 7 (OR 0.41; 95% CI 0.16-0.88; p=0.04). E-AKI was associated with 1-year mortality (OR 1.65; 95% CI 1.03-2.64; p=0.04) and chronic kidney disease progression (OR 2.23; 95% CI 1.30-3.82; p<0.01). CONCLUSIONS: E-AKI is common in IE and often associated with non-modifiable variables. Multidisciplinary management should be mandatory, and awareness of AKI diagnosis and etiological explorations should be raised.
Authors: Ana Lopez-de-Andres; Rodrigo Jimenez-Garcia; Valentin Hernández-Barrera; Javier de-Miguel-Díez; Jose M de-Miguel-Yanes; David Martinez-Hernandez; David Carabantes-Alarcon; Jose J Zamorano-Leon; Concepción Noriega Journal: Cardiovasc Diabetol Date: 2022-09-30 Impact factor: 8.949