Risk factors and outcomes of early acute kidney injury in infective endocarditis: A retrospective cohort study

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.

Keywords

• Infective endocarditis
• Acute kidney injury
• Outcome
• Infectious diseases team