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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (4): 737-741. doi: 10.19723/j.issn.1671-167X.2019.04.025

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Clinical features and prognosis of infective endocarditis patients with acute kidney injury

Si-yu ZHANG(),Xi-hui LI,Feng XIAO   

  1. Department of Cardiac Surgery, Peking University First Hospital, Beijing 100034, China
  • Received:2018-11-12 Online:2019-08-18 Published:2019-09-03
  • Contact: Si-yu ZHANG E-mail:siyuzh@qq.com

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Abstract:

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 diffe-rence 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.

Key words: Acute kidney injury, Endocarditis, bacterial, Cardiac surgical procedures

CLC Number: 

  • R542.42

Table 1

Comparison of clinical features of two groups"

Items AKI group
(n=21)		 Non-AKI group
(n=79)		 P
Age/years 45.9±14.5 43.3±16.3 0.511
Male 13 (61.9) 62 (78.5) 0.119
Hypertension 7 (33.3) 25 (31.6) 0.883
Diabetes 4 (19.0) 7 (8.9) 0.185
Fever 19 (90.5) 71 (89.9) 0.935
Lower limbs edema 11 (52.4) 13 (16.5) 0.001
Rash 6 (28.6) 7 (8.9) 0.017
Arthralgia 2 (9.5) 8 (10.1) 0.935
Short of breath 11 (52.4) 32 (40.5) 0.329
Stroke 1 (4.8) 16 (20.3) 0.093
Hemoglobin/(g/L) 96.1±15.0 116.0±20.7 <0.001
Peak SCr preoperation/
(μmol/L)		 313.0±187.5 87.8±19.2 <0.001
Alb/(g/L) 32.4±6.2 37.6±5.7 <0.001
CRP/(mg/L) 54.5±42.1 64.7±56.5 0.442
Urine blood positive 14 (66.7) 20 (25.3) <0.001
Urine protein positive 20 (95.2) 29 (36.7) <0.001
LVEF/% 63.7±11.9 66.5±9.3 0.249
NYHAⅢ-Ⅳ 9 (42.9) 16 (20.3) 0.033

Table 2

Pathogenic bacteria comparison between AKI and non-AKI group"

Items AKI group
(n=21)		 Non-AKI group
(n=79)		 P
Blood culture positive,n (%) 9 (42.9) 45 (57.0) 0.249
Pathogenic bacteria, n (%)
Streptococci 3 (14.3) 28 (35.4) 0.062
Staphylococcus 3 (14.3) 8 (10.1) 0.588
Enterococcus 1 (4.8) 4 (5.1) 0.955
G- bacillus 2 (9.5) 5 (6.3) 0.610

Table 3

Comparison of vegetation location between AKI and non-AKI groupn (%)"

Vegetation location AKI group
(n=21)		 Non-AKI group
(n=79)		 P
Aorta valve 14 (66.7) 38 (48.1)) 0.130
Mitral valve 8 (38.1) 45 (57.0) 0.124
Other 3 (14.3) 6 (7.6) 0.341

Table 4

Comparison of perioperative complications between two groups"

Items AKI group (n=19) Non-AKI group (n=72) P
Surgery, n (%)
Valve replacement 17 (89.5) 65 (90.3) 0.917
CHD repair 4 (21.1) 7 (9.7) 0.178
CABG 1 (5.3) 4 (5.6) 0.960
Operative condition, x?±s
CPB duration/min 128.3±58.9 115.9±48.2 0.344
Aortic clamping duration/min 92.6±54.6 81.7±36.5 0.419
RBC transfusion/IU 7.7±3.7 5.0±3.9 0.010
Drainage after surgery/mL 1 048.9±655.8 758.9±565.3 0.058
Complications, n (%)
Prolonged ventilation time 6 (31.6) 8 (11.1) 0.028
Prolonged ICU stay time 12 (63.2) 19 (26.4) 0.003
Low cardiac output 2 (10.5) 2 (2.8) 0.143
New onset of AF 4 (21.1) 6 (8.3) 0.115
New onset of stroke 1 (5.3) 4 (5.6) 0.960
Acute kidney injury 13 (68.4) 23 (31.9) 0.004
In-hospital death 0 2 (2.8) 0.463

Figure 1

Survival curves of AKI and non-AKI group"

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