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

Tokarski, F. Von; Lemaignen, Adrien; Portais, Antoine; Fauchier, Laurent; Hennekinne, Fanny; Sautenet, Bénédicte; Legras, Annick; Patat, F.; Bourguignon, Thierry; Mirguet, C.; Bernard, Anne; Bernard, Louis

doi:10.1016/j.ijid.2020.08.022

Cited by 22 publications

(21 citation statements)

References 27 publications

(31 reference statements)

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“…Second, infection and heart failure in IE are accompanied by the excessive activation of the body's immune system, a loss of appetite and dietary restrictions in patients, which often lead to the consumption of nutrients and the further reduction of albumin (19). Finally, acute renal failure occurs in about 6-30% of IE patients and is a common complication in this population, which results in the loss of albumin from urine (2,14). These causes are also risk factors of in-hospital death and postoperative adverse cardiovascular events in IE patients (12)(13)(14)(15)20).…”

Section: Discussionmentioning

confidence: 99%

“…Finally, acute renal failure occurs in about 6-30% of IE patients and is a common complication in this population, which results in the loss of albumin from urine (2,14). These causes are also risk factors of in-hospital death and postoperative adverse cardiovascular events in IE patients (12)(13)(14)(15)20). Conversely, from the perspective of pathophysiological function, albumin may have a protective effect on inflammation and oxidative stress-related endothelial dysfunction (21), and the normal function of the immune response system depends on metabolism and nutritional status (19).…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that albumin is also decreased in IE patients (11), and the cause is not only malnutrition but also inflammation, infection, and renal insufficiency. Among these factors, severe sepsis, malnutrition and acute kidney injury are also high-risk factors for the morbidity and mortality of IE (12)(13)(14)(15). Preoperative hypoalbuminemia represents the sum of different factors associated with poor surgical outcomes in IE.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative serum albumin: a promising indicator of early mortality after surgery for infective endocarditis

Huang¹,

Zhou²,

Luo³

et al. 2021

Ann Transl Med

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Background: Despite novel improvements in the diagnosis and treatment of infective endocarditis (IE), there has been no significant improvement in the survival rate of IE, which indicates that many details still need to be optimized in the preoperative assessment. We sought to evaluate preoperative serum albumin as a biomarker for predicting early mortality after IE surgery.Methods: Between October 2013 and June 2019, patients with a definite diagnosis of IE were enrolled in this study. Patients' albumin levels at admission were used as the preoperative albumin levels. Restricted cubic spline and multivariate logistic regression analyses were performed to evaluate the relationship between albumin and early mortality. Receiver operating characteristic curve analyses were performed to assess the role of albumin in predicting early mortality and compare the predictive capacity of traditional models with models that included albumin. Results: Of the 276 IE patients, 20 (7.2%) died in hospital or within 30 days of surgery. Hypoalbuminemia (an albumin level <3.5 g/dL) was present in 109 (39.5%) patients. The multivariate logistic regression analysis showed that preoperative albumin was inversely associated with early mortality [adjusted odds ratio (OR) =0.22 per 1 g/dL, 95% confidence interval (CI): 0.07-0.65, P=0.006] after full adjustment. Preoperative albumin had value in predicting early mortality [area under the curve (AUC) =0.72, 95% CI: 0.61-0.84; P<0.01]. After adding albumin to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Charlson score, the predictive ability of the model was further improved (EuroSCORE II: AUC =0.55;

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Preoperative serum albumin: a promising indicator of early mortality after surgery for infective endocarditis

Huang¹,

Zhou²,

Luo³

et al. 2021

Ann Transl Med

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“…Finally, death-censored graft survival after IE also appeared unexpectedly low, with half of the grafts lost after four years, versus 13% in the controls after the same delay. Endocarditis is known to result in acute and long-term kidney complications [ 30 ] due to infectious, post-infectious, immunological, or drug-related mechanisms. Our study was not designed to explore the cause of renal failure in the patients who were included.…”

Section: Discussionmentioning

confidence: 99%

High Mortality and Graft Loss after Infective Endocarditis in Kidney Transplant Recipients: A Case-Controlled Study from Two Centers

et al. 2021

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Kidney transplant recipients (KTRs) tend to develop infections with characteristic epidemiology, presentation, and outcome. While infective endocarditis (IE) is among such complications in KTRs, the literature is scarce. We describe the presentation, epidemiology, and factors associated with IE in KTRs. We performed a retrospective case/control study which included patients from two centers. First episodes of definite or possible IE (Duke criteria) in adult KTRs from January 2010 to December 2018 were included, as well as two controls per case, and followed until 31 December 2019. Clinical, biological, and microbiological data and the outcome were collected. Survival was studied using the Kaplan–Meier method. Finally, we searched for factors associated with the onset of IE in KTRs by the comparison of cases and controls. Seventeen cases and 34 controls were included. IE was diagnosed after a mean delay of 78 months after KT, mostly on native valves of the left heart only. Pathogens of digestive origin were most frequently involved (six Enterococcus spp, three Streptococcus gallolyticus, and one Escherichia coli), followed by Staphylococci (three cases of S. aureus and S. epidermidis each). Among the risk factors evaluated, age, vascular nephropathy, and elevated calcineurin inhibitor through levels were significantly associated with the occurrence of IE in our study. Patient and death-censored graft survival were greatly diminished five years after IE, compared to controls being 50.3% vs. 80.6% (p < 0.003) and 29.7% vs. 87.5% (p < 0.002), respectively. IE in KTRs is a disease that carries significant risks both for the survival of the patient and the transplant.

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“…Importantly, we should be careful about Contrast-Induced Nephropathy (CIN) when performing cerebral CTA. A retrospective cohort study showed that the incidence of acute kidney injury (AKI) was 54.3% in infective endocarditis patients [14]. Implementation of a preventive strategy involving good hydration pre-and post-CT together with the use of low osmolality contrast media will reduce the risk of CIN [15].…”

Section: Discussionmentioning

confidence: 99%

Cerebral Hemorrhagic Manifestation of Extra-Cardiac Infective Endocarditis: What Diagnostic Approach Should Be Taken?

Mansour¹

2021

Int Arch Vasc Med

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Introduction: Infective endocarditis results from microbial infection of intracardiac structures and is highly fatal if untreated. The infection is typically clinically silent prior to the onset of cerebral hemorrhagic events.Case description: A 56-year-old male with a history of mitral valve replacement presented to the emergency department complaining of vague symptoms combined with neurological and cardiac problems. The patient was admitted, and medical investigations were performed. Blood tests and cultures indicated that the patient suffered from infective endocarditis. Echocardiography showed the presence of vegetation on the mitral valve with features of infective endocarditis. Non-contrast brain CT revealed no abnormalities. The patient was administered antibiotic therapy. After two days, the patient's status deteriorated. A second non-contrast brain CT was performed and showed an intracerebral hemorrhage. Discussion: Cerebral hemorrhages occur rarely in infective endocarditis. These hemorrhages are usually attributed to ruptured mycotic aneurysms. Early screening of neurological complications by cerebral CTA will improve the treatment decision and outcome in patients with infective endocarditis and decrease the mortality rate of these cases.

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

Cited by 22 publications

References 27 publications

Preoperative serum albumin: a promising indicator of early mortality after surgery for infective endocarditis

Preoperative serum albumin: a promising indicator of early mortality after surgery for infective endocarditis

High Mortality and Graft Loss after Infective Endocarditis in Kidney Transplant Recipients: A Case-Controlled Study from Two Centers

Cerebral Hemorrhagic Manifestation of Extra-Cardiac Infective Endocarditis: What Diagnostic Approach Should Be Taken?

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