Association of Renal Impairment Severity with Surgical Outcomes in Patients with Infective Endocarditis

This study aimed to assess the association of renal impairment (RI) severity on short and mid-term outcomes in patients undergoing cardiac surgery for infective endocarditis (IE).

Patients undergoing cardiac surgery for IE between January 2010 and October 2022 were included. They were stratified based on preoperative renal function into four groups: Normal (N: Creatinine clearance (CrCl) >85 mL/min), moderate RI (M: CrCl 51-85 mL/min), severe RI (S: CrCl ≤50 mL/min), and haemodialysis-dependent (H). Each group was compared with group N. Survival analysis was performed using Kaplan-Meier curves.

A total of 487 patients (N: 198; M: 154; S: 96; H: 39) were included. Mean age 55.92 ± 14.60 years, 375 (77%) males. Groups M, S, and H vs N demonstrated more atrial fibrillation [17 (11.0%), 20 (20.8%), 6 (15.4%) vs 8 (4.0%); p<0.05]. Groups S and H vs. N had increased incidence of left ventricular ejection fraction <50% [43 (44.8%), 22 (56.4%) vs 43 (21.7%); p<0.001] and preoperative cardiogenic shock [16 (16.7%), 13 (33.3%) vs 9 (4.5%); p<0.001]. The need for postoperative haemodialysis was 21 (13.6%) in M and 23 (23.0%) in S vs. 13 (6.6%) in N (p<0.05). In-hospital mortality was 13 (8.4%), 21 (21.9%), and 11 (28.2%) vs. 12 (6.1%) (p=0.388, <0.001, <0.001), and mortality at a mean of 69.1months was 49 (31.8%), 46 (46.9%), 30 (76.9%) vs. 49 (24.7%) (p=0.142, <0.001, <0.001) in groups M, S, H vs. N, respectively.

The incidence of renal impairment in patients with IE undergoing surgery remains high. Early and mid-term outcomes of those with severe RI and haemodialysis dependence are significantly worse.