Risk factors and outcomes of early acute kidney injury in infective endocarditis: A retrospective cohort study. (October 2020)

• Record Type: Journal Article
• Authors: Von Tokarski, Florent; Lemaignen, Adrien; Portais, Antoine; Fauchier, Laurent; Hennekinne, Fanny; Sautenet, Bénédicte; Halimi, Jean-Michel; Legras, Annick; Patat, Frédéric; Bourguignon, Thierry; Mirguet, Christian; Bernard, Anne; Bernard, Louis
• Is Part Of: International journal of infectious diseases. Volume 99(2020)
• Page Start: 421
• Page End: 427
• Publication Date: 2020-10
• Subjects: Infective endocarditis -- Acute kidney injury -- Outcome -- Infectious diseases team; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.08.022
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Acute kidney injury (AKI) occurred in 52.7% of patients with infective endocarditis. Staphylococcus aureus was the most common species and was associated with AKI. An infectious disease consultation appeared to be a protective factor for AKI. Exploration of AKI needs to be systematic to conclude on its aetiologies. Among the 69% patients who survived at one year, 32% had chronic kidney disease. 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.