Key result
Infective endocarditis patients with acute kidney injury had higher rates of perioperative complications but no significant difference in in-hospital mortality (4.8% vs 3.8%, p=0.594) or long-term survival compared to those without AKI.
Why the study?
The study was conducted to investigate the clinical features and treatment of infective endocarditis patients with acute kidney injury, and to compare their adverse complications and outcomes with patients without acute kidney injury.
Does acute kidney injury worsen prognosis and increase perioperative complications in patients with infective endocarditis?
Cohort (n=200)
No
Does acute kidney injury worsen prognosis and increase perioperative complications in patients with infective endocarditis?
Absolute Event Rate: 4.8% vs 3.8%
p-value: p=0.594
In patients with infective endocarditis, concomitant acute kidney injury is associated with more perioperative complications but does not significantly impact in-hospital or long-term mortality.
AKI in infective endocarditis associates with more perioperative complications but not mortality; leaves open whether prevention strategies improve outcomes.
OBJECTIVE: To investigate the clinical features and treatment of infective endocarditis (IE) patients with acute kidney injury (AKI), and to compare the adverse complications and outcome with IE patients without AKI. METHODS: Clinical data of 100 IE cases in Peking University First Hospital from January 2002 to June 2018 were retrospectively reviewed. The patients were divided into AKI group (n=21) and non-AKI group (n=79) based on the AKI network (AKIN) definition. The clinical data and prognosis were compared between the two groups. RESULTS: The incidence of AKI was 21%. The average age was (43.7±15.7) years, and the ratio of male to female was 3 ∶1. There was no significant difference in age and gender between the two groups. Compared with non-AKI group, the AKI group had more rash and lower limbs edema (P=0.017 and P=0.001), higher urine blood and protein positive rate (both P<0.001). Lower hemoglobin and serum albumin level (both P<0.001), worse clinical cardiac function (NYHA III-IV, P=0.033) were found in AKI group compared with non-AKI group. There was no significant difference in microbiologic positive rate and pathogenic bacteria sorts between the two groups. Nine patients refused surgery, and the other 91 cases underwent cardiac surgery with cardiopulmonary bypass under general anesthesia, including 19 cases of AKI group and 72 cases of non-AKI group. The ventilation time and intensive care unit (ICU) stay time were longer in AKI group than in non-AKI group (P=0.028 and P=0.003). AKI group needed more red blood cell transfusion (P=0.010). Using the last serum creatinine before surgery as basic level, there was more new-onset AKI cases in AKI group than in non-AKI group. During the median follow-up time 42 months, there was no significant difference in perioperative and follow-up mortality between the two groups (P=0.463 and P=0.581). CONCLUSION: More perioperation complications occurred in IE patients with AKI, but no significant difference in in-hospital and follow-up mortality between the AKI and non-AKI groups was observed.
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Zhang et al. (2019) conducted a cohort in Infective endocarditis with acute kidney injury (n=200). Acute kidney injury (AKI) vs. Non-AKI was evaluated on In-hospital mortality (p=0.594). Infective endocarditis patients with acute kidney injury had higher rates of perioperative complications but no significant difference in in-hospital mortality (4.8% vs 3.8%, p=0.594) or long-term survival compared to those without AKI.
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