In surgery for left-sided infective endocarditis, acute kidney injury requiring renal replacement therapy was the strongest predictor of inhospital mortality (OR 28.62; 95% CI 6.51-125.96; p<0.001).
Observational (n=216)
No
What are the postoperative complications and predictors of inhospital mortality in patients undergoing surgery for left-sided infective endocarditis?
In patients undergoing surgery for left-sided infective endocarditis, inhospital mortality is 8.6%, with key predictors including lower creatinine clearance, longer cardiopulmonary bypass time, delirium, and acute kidney injury requiring renal replacement therapy.
Odds Ratio: 28.62 (95% CI 6.508–125.964)
p-value: p=<0.001
Aim. To assess postoperative complications and predictors of mortality in surgery for left-sided infective endocarditis (IE). Material and methods . The retrospective analysis included 222 cases of IE in 216 patients who were operated on from January 2015 to November 2022. Inclusion criteria: age of patients ≥18 years, definite or probable (Duke criteria) left-sided IE of aortic and/or mitral valves. There were following exclusion criteria: isolated right-sided IE (tricuspid valve, pacemaker endocarditis), nonbacterial thrombotic endocarditis and chronic IE. Endpoints: inhospital mortality, postoperative complications (delirium; perioperative stroke; resternotomy for bleeding; perioperative myocardial infarction; acute heart failure requiring extracorporeal membrane oxygenation or intra-aortic balloon pumping; respiratory failure requiring tracheostomy; acute kidney injury requiring renal replacement therapy; conduction disorder requiring pacemaker implantation). Results . Median age was 53 38,0; 61,0 years, while the majority of patients were men (73,9%). Inhospital mortality was 8,6%. The most common postoperative complications were delirium (19,8%) and bleeding requiring resternotomy (10,4%). The incidence of perioperative stroke was 2,3%, perioperative myocardial infarction - 0,9%, respiratory failure with tracheostomy – 4,5%, pacemaker implantation – 2,7%, renal replacement therapy – 6,8%. According to multivari ate analysis, Predictors of inhospital mortality were creatinine clearance level (odds ratio (OR), 0,976; 95% confidence interval (CI): 0,956-0,996; p=0,020), time of cardiopulmonary bypass (OR, 1,014; 95% CI: 1,006-1,021 , p<0,001), deli rium (OR, 7,058; 95% CI: 1,824-27,330, p=0,005) and acute kidney injury requiring renal replacement therapy (OR, 28,620; 95% CI: 6,508-125,964; p<0,001). Conclusion. Surgical treatment of left-sided IE has satisfactory inho spital outcomes. The study identified simple clinical factors (creatinine clearance, cardiopulmonary bypass time, delirium, acute kidney injury) associated with inhospital mortality.
Enginoev et al. (2023) conducted an observational in Left-sided infective endocarditis (n=216). Acute kidney injury requiring renal replacement therapy vs. No acute kidney injury requiring renal replacement therapy was evaluated on Inhospital mortality (OR 28.620, 95% CI 6.508-125.964, p=<0.001). In surgery for left-sided infective endocarditis, acute kidney injury requiring renal replacement therapy was the strongest predictor of inhospital mortality (OR 28.62; 95% CI 6.51-125.96; p<0.001).