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

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. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.