Hospital Mortality of Cardiac Surgery Patients with Infective Endocarditis and Acute Kidney Injury on Renal Replacement Therapy

Abstract

Infective endocarditis (IE) and acute kidney injury (AKI) are known risk factors in cardiac surgery patients. The rate of renal replacement therapy (RRT) in cardiac surgery patients ranged from 2% to 6% of cases.Objective. To compare the impact of different RRT methods on outcomes in treatment of cardiac surgery patients with and without IE and with acute renal injury.Materials and methods. The study included prospectively 106 patients with AKI who were operated from 2015 to 2018 (40 patients with a diagnosis of IE (IE+), 66 patients with valvular heart disease (IE–)), who required RRT. Patients were randomly assigned to continuous hemodialysis (CHD), slow low efficiency daily hemodialysis (SLEDD), continuous veno-venous hemofiltration (CVVHDF), and high-volume hemofiltration (HVHF). Patients treated with CHD and HVHF were combined into a group of intermittent RRT (n = 57), and patients treated with CVVHDF and SLEDD formed a group of continuous RRT (n = 49). At the same time, patients treated with CHD and SLEDD (n = 46) were grouped into the RRT group based on the diffusion principle, and the CVVHDF and HVHF patients were grouped into the RRT group based on the convection principle (n = 60).Results. RRT before surgery was initiated in 18 (45%) patients in the IE+ group and in 23 patients (34.8%) in the IE–group (p > 0.05). Among these groups 2 (5%) and 4 (6.1%) patients respectively (p > 0.05) died before surgery. The hospital mortality rate in cardiac surgery patients with AKI, who required RRT, was 35.8% (38 patients) and statistically there was no significant difference from the predicted mortality on the APACHE II scale (22 points – 42%, p = 0.192). In this case, hospital mortality in the IE+ group was statistically significantly lower than in the IE– group (7 patients (17.5%) and 31 patients (47%), respectively, p = 0.002). It was found that the use of CVVHDF can statistically significantly reduce hospital mortality in cardiac surgery patients with AKI and IE to 30.9% compared with the predicted mortality on the APACHE II scale (11.1% and 42%, respectively, p = 0.001).Conclusions. The use of CVVHDF in cardiac surgery patients with AKI and IE allowed to reduce hospital mortality compared to APACHE II predicted level, to even lower rates than in cardiac surgery patients with valvular heart disease and AKI.