Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun;10(6):3679-3688.
doi: 10.21037/jtd.2018.06.11.

Risk factors and short-term prognosis of preoperative renal insufficiency in infective endocarditis

Yang Liu  1 , Hang Zhang  2   3 , Yaoyang Liu  4 , Qingqi Han  1 , Yangfeng Tang  1 , Libo Zhao  1 , Fan Qiao  1 , Zhiyun Xu  1 , Min Yu  2   3 , Zhongxiang Yuan  2   3
Affiliations

Risk factors and short-term prognosis of preoperative renal insufficiency in infective endocarditis

Yang Liu et al. J Thorac Dis. 2018 Jun.

Abstract

Background: The incidence of postoperative complications and the in-hospital mortality rate of infective endocarditis (IE) complicated with renal insufficiency are relatively high. This study aimed to analyze the clinical features, etiological characteristics, diagnosis and treatment, and prognosis of IE with renal insufficiency and to explore the risk factors for renal damage.

Methods: IE patients undergoing valvular surgery between 2008 and 2017 in two cardiac centers were retrospectively analyzed. They were divided into renal insufficiency (RI) [endogenous creatinine clearance rate (Ccr) <60 mL/min/1.73 m2] and normal renal function (NRF) (Ccr ≥60 mL/min/1.73 m2) groups. The disease conditions at admission, etiology, treatment, and prognosis were compared between the two groups. Multivariate regression analysis was performed for the related factors.

Results: A total of 8,055 cases of valvular surgery was performed during the study period. We analyzed 401 IE patients [average age 43.9±15 years; RI, n=56 (14%); NRF, n=345 (86%)], after the exclusion of 2 patients with primary glomerulonephritis. RI patients showed higher perioperative mortality (14.3% vs. 4.5%, P=0.042) and streptococcal infection (71.4% vs. 43.8%, P=0.001) rates. The RI group was also older and had worse heart function, greater decreases in hemoglobin and platelet levels, a higher rate of prosthetic valve involvement, more cases of postoperative dialysis, and worse prognosis (all P<0.05). Binary logistic multivariate regression analysis showed that the incidence of streptococcal infection [odds ratio (OR) =4.271, 95% confidence interval (CI), 1.846-9.884; P=0.001], age ≥51 years (OR =5.138, 95% CI, 2.258-11.694; P<0.001), and New York Heart Association (NYHA) functional class III-IV (OR =10.768, 95% CI, 2.417-47.972; P=0.002) were independent risk factors for preoperative renal insufficiency.

Conclusions: IE patients with preoperative renal insufficiency had a high mortality rate and poor prognosis, with streptococcal infection predisposing to a higher risk of renal insufficiency. Moreover, older the age and worse heart function in IE resulted in a greater risk for renal insufficiency.

Keywords: Infective endocarditis; cardiac surgery; etiology; renal insufficiency.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart of the study selection.
Figure 2
Figure 2
Histopathology of the renal tissue [arrow, formation of the glomerular cell type crescent, hematoxylin-eosin staining (200×)].
See this image and copyright information in PMC

References

    1. Bashore TM, Cabell C, Fowler V., Jr Update on infective endocarditis. Curr Probl Cardiol 2006;31:274-352. 10.1016/j.cpcardiol.2005.12.001 - DOI - PubMed
    1. Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 2009;30:2369-413. 10.1093/eurheartj/ehp285 - DOI - PubMed
    1. Murdoch DR, Corey GR, Hoen B, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med 2009;169:463-73. 10.1001/archinternmed.2008.603 - DOI - PMC - PubMed
    1. Neragi-Miandoab S, Skripochnik E, Michler R, et al. Risk factors predicting the postoperative outcome in 134 patients with active endocarditis. Heart Surg Forum 2014;17:E35-41. 10.1532/HSF98.2013270 - DOI - PubMed
    1. Tamura K, Arai H, Yoshizaki T. Long-term outcome of active infective endocarditis with renal insufficiency in cardiac surgery. Ann Thorac Cardiovasc Surg 2012;18:216-21. 10.5761/atcs.oa.11.01748 - DOI - PubMed

LinkOut - more resources