Acute Kidney Injury after Cardiac Surgery for Infective Endocarditis: AKICSIE study

The incidence of infective endocarditis (IE) is increasing, and cardiac surgery for IE carries a high risk of postoperative acute kidney injury (AKI). However, data on risk factors, renal recovery, and associated outcomes remain limited.

We conducted a retrospective study of adult patients who underwent cardiac surgery for IE between 2013 and 2023. The primary objective was to identify risk factors for AKI onset or progression after cardiac surgery for IE.

Among the 1,359 patients who underwent IE surgery, 750 were included in the study. Postoperative AKI occurred in 362 of them (48.3%). In multivariable analysis restricted to preoperative and intraoperative variables, postoperative AKI was independently associated with older age (OR 1.023 [1.010-1.036]), higher EuroSCORE II (OR 1.029 [1.014-1.045]), red blood cell transfusion (OR 1.119 [1.074-1.166]), multivalvular involvement (OR 1.876 [1.198-2.936]), and preoperative exposure to nephrotoxic agents in a dose-dependent manner (OR 1.798 [1.194-2.708] for 2-3 drugs and OR 3.699 [1.806-7.578] for ≥4 drugs vs. ≤1). Six-month mortality was 36.9% in patients with no renal recovery, compared to 5.6-8.5% in those who recovered (p < 0.001). Among 469 patients with 6-month renal follow-up, major adverse kidney events occurred in 29.9%, increasing with AKI severity from 16.2% in patients without AKI to 67.5% in KDIGO stage 3 (p < 0.001).

Postoperative AKI affects nearly half of patients undergoing surgery for IE. Preoperative nephrotoxic drug exposure and red blood cell transfusion were the only modifiable risk factors identified.