Outcomes of patients with infective endocarditis-associated acute kidney injury: a retrospective cohort study

The outcomes of patients with infective endocarditis (IE)-associated acute kidney injury (AKI) are poorly understood.

This retrospective cohort study was conducted in a tertiary hospital in China to analyze the short- and long-term outcomes among patients with IE-associated AKI. The risk factors for 90-day mortality, long-term outcomes and kidney non-recovery were analyzed via multivariable logistic regression, the Cox regression, and the Fine-Gray competing risk model, respectively.

Among 294 patients with IE-associated AKI, 14.3% died within 90 days, and the risk factors for 90-day mortality were similar to those identified in the general IE population. Among the 230 AKI survivors in whom 90-day kidney recovery could be assessed, 17.4% did not recover kidney function at 90 days. Kidney non-recovery at 90 days was associated with an increased risk of the long-term composite outcome of mortality, end-stage renal disease or sustained doubling of serum creatinine [hazard ratio (HR) 3.00, 95% confidence interval (CI) 1.19-7.59]. Five variables were related to kidney non-recovery: low baseline estimated glomerular filtration rate (eGFR) (HR 2.52, 95% CI 1.73-3.65), stage of AKI (HR 3.03, 95% CI 2.07-4.42 for stage 3), shock (HR 5.56, 95% CI 3.02-10.22), glomerulonephritis-related AKI (HR 3.04, 95% CI 1.93-4.77) and drug-related AKI (HR 2.77, 95% CI 1.86-4.13).

Patients with IE-associated AKI had a high 90-day mortality, and a substantial proportion of survivors did not recover kidney function at 90 days. Kidney non-recovery at 90 days was associated with adverse long-term outcomes. Low baseline eGFR, severe AKI, shock, drug-related AKI and glomerulonephritis-related AKI were risk factors for kidney non-recovery.