Abstract
IntroductionCardiac surgery is frequently needed in patients with infective endocarditis (IE). Acute kidney injury (AKI) often complicates IE and is associated with poor outcomes. The purpose of the study was to determine the risk factors for post-operative AKI in patients operated on for IE.MethodsA retrospective, non-interventional study of prospectively collected data (2000–2010) included patients with IE and cardiac surgery with cardio-pulmonary bypass. The primary outcome was post-operative AKI, defined as the development of AKI or progression of AKI based on the acute kidney injury network (AKIN) definition. We used ensemble machine learning (“Super Learning”) to develop a predictor of AKI based on potential risk factors, and evaluated its performance using V-fold cross validation. We identified clinically important predictors among a set of risk factors using Targeted Maximum Likelihood Estimation.Results202 patients were included, of which 120 (59%) experienced a post-operative AKI. 65 (32.2%) patients presented an AKI before surgery while 91 (45%) presented a progression of AKI in the post-operative period. 20 patients (9.9%) required a renal replacement therapy during the post-operative ICU stay and 30 (14.8%) died during their hospital stay. The following variables were found to be significantly associated with renal function impairment, after adjustment for other risk factors: multiple surgery (OR: 4.16, 95% CI: 2.98-5.80, p<0.001), pre-operative anemia (OR: 1.89, 95% CI: 1.34-2.66, p<0.001), transfusion requirement during surgery (OR: 2.38, 95% CI: 1.55-3.63, p<0.001), and the use of vancomycin (OR: 2.63, 95% CI: 2.07-3.34, p<0.001), aminoglycosides (OR: 1.44, 95% CI: 1.13-1.83, p=0.004) or contrast iodine (OR: 1.70, 95% CI: 1.37-2.12, p<0.001). Post-operative but not pre-operative AKI was associated with hospital mortality.ConclusionsPost-operative AKI following cardiopulmonary bypass for IE results from additive hits to the kidney. We identified several potentially modifiable risk factors such as treatment with vancomycin or aminoglycosides or pre-operative anemia.
Highlights
Cardiac surgery is frequently needed in patients with infective endocarditis (IE)
Patients Between January 2000 and December 2010, all consecutive patients admitted to the Hôpital Européen Georges Pompidou (Paris, France), an 800-bed university hospital with a dedicated infectious unit specializing in treatment of patients with IE, with the diagnosis of IE according to the modified Duke criteria [11] and who underwent cardiac surgery with cardiopulmonary bypass were included
21 were excluded (9 because of renal replacement therapy (RRT) before surgery, 4 did not undergo surgery, 5 died during surgery, 3 had incomplete files) and 202 patients were included with a median age of 42 (28 to 59) years
Summary
Cardiac surgery is frequently needed in patients with infective endocarditis (IE). Acute kidney injury (AKI) often complicates IE and is associated with poor outcomes. Acute kidney injury (AKI) is a common complication following cardiac surgery, occurring in 5 to 20% of the patients [2,3,4,5]. It has been associated with increased mortality [3,6,7]. The aim of the present study was to describe the incidence of AKI patients undergoing operation for an acute episode of endocarditis, and to identify the risk factors for post-operative AKI or worsening of renal function in these patients
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