PMID- 30069366
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220318
IS  - 2072-1439 (Print)
IS  - 2077-6624 (Electronic)
IS  - 2072-1439 (Linking)
VI  - 10
IP  - 6
DP  - 2018 Jun
TI  - Risk factors and short-term prognosis of preoperative renal insufficiency in 
      infective endocarditis.
PG  - 3679-3688
LID - 10.21037/jtd.2018.06.11 [doi]
AB  - BACKGROUND: The incidence of postoperative complications and the in-hospital 
      mortality rate of infective endocarditis (IE) complicated with renal 
      insufficiency are relatively high. This study aimed to analyze the clinical 
      features, etiological characteristics, diagnosis and treatment, and prognosis of 
      IE with renal insufficiency and to explore the risk factors for renal damage. 
      METHODS: IE patients undergoing valvular surgery between 2008 and 2017 in two 
      cardiac centers were retrospectively analyzed. They were divided into renal 
      insufficiency (RI) [endogenous creatinine clearance rate (Ccr) <60 mL/min/1.73 
      m(2)] and normal renal function (NRF) (Ccr >/=60 mL/min/1.73 m(2)) groups. The 
      disease conditions at admission, etiology, treatment, and prognosis were compared 
      between the two groups. Multivariate regression analysis was performed for the 
      related factors. RESULTS: A total of 8,055 cases of valvular surgery was 
      performed during the study period. We analyzed 401 IE patients [average age 
      43.9+/-15 years; RI, n=56 (14%); NRF, n=345 (86%)], after the exclusion of 2 
      patients with primary glomerulonephritis. RI patients showed higher perioperative 
      mortality (14.3% vs. 4.5%, P=0.042) and streptococcal infection (71.4% vs. 43.8%, 
      P=0.001) rates. The RI group was also older and had worse heart function, greater 
      decreases in hemoglobin and platelet levels, a higher rate of prosthetic valve 
      involvement, more cases of postoperative dialysis, and worse prognosis (all 
      P<0.05). Binary logistic multivariate regression analysis showed that the 
      incidence of streptococcal infection [odds ratio (OR) =4.271, 95% confidence 
      interval (CI), 1.846-9.884; P=0.001], age >/=51 years (OR =5.138, 95% CI, 
      2.258-11.694; P<0.001), and New York Heart Association (NYHA) functional class 
      III-IV (OR =10.768, 95% CI, 2.417-47.972; P=0.002) were independent risk factors 
      for preoperative renal insufficiency. CONCLUSIONS: IE patients with preoperative 
      renal insufficiency had a high mortality rate and poor prognosis, with 
      streptococcal infection predisposing to a higher risk of renal insufficiency. 
      Moreover, older the age and worse heart function in IE resulted in a greater risk 
      for renal insufficiency.
FAU - Liu, Yang
AU  - Liu Y
AD  - Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical 
      University, Shanghai 200433, China.
FAU - Zhang, Hang
AU  - Zhang H
AD  - Department of Cardiovascular Surgery, Shanghai General Hospital, Nanjing Medical 
      University, Shanghai 200080, China.
AD  - Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao 
      Tong University School of Medicine, Shanghai 200080, China.
FAU - Liu, Yaoyang
AU  - Liu Y
AD  - Department of Rheumatology and Immunology, Changzheng Hospital, Second Military 
      Medical University, Shanghai 200003, China.
FAU - Han, Qingqi
AU  - Han Q
AD  - Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical 
      University, Shanghai 200433, China.
FAU - Tang, Yangfeng
AU  - Tang Y
AD  - Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical 
      University, Shanghai 200433, China.
FAU - Zhao, Libo
AU  - Zhao L
AD  - Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical 
      University, Shanghai 200433, China.
FAU - Qiao, Fan
AU  - Qiao F
AD  - Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical 
      University, Shanghai 200433, China.
FAU - Xu, Zhiyun
AU  - Xu Z
AD  - Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical 
      University, Shanghai 200433, China.
FAU - Yu, Min
AU  - Yu M
AD  - Department of Cardiovascular Surgery, Shanghai General Hospital, Nanjing Medical 
      University, Shanghai 200080, China.
AD  - Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao 
      Tong University School of Medicine, Shanghai 200080, China.
FAU - Yuan, Zhongxiang
AU  - Yuan Z
AD  - Department of Cardiovascular Surgery, Shanghai General Hospital, Nanjing Medical 
      University, Shanghai 200080, China.
AD  - Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao 
      Tong University School of Medicine, Shanghai 200080, China.
LA  - eng
PT  - Journal Article
PL  - China
TA  - J Thorac Dis
JT  - Journal of thoracic disease
JID - 101533916
PMC - PMC6051850
OTO - NOTNLM
OT  - Infective endocarditis
OT  - cardiac surgery
OT  - etiology
OT  - renal insufficiency
COIS- Conflicts of Interest: The authors have no conflicts of interest to declare.
EDAT- 2018/08/03 06:00
MHDA- 2018/08/03 06:01
PMCR- 2018/06/01
CRDT- 2018/08/03 06:00
PHST- 2018/08/03 06:00 [entrez]
PHST- 2018/08/03 06:00 [pubmed]
PHST- 2018/08/03 06:01 [medline]
PHST- 2018/06/01 00:00 [pmc-release]
AID - jtd-10-06-3679 [pii]
AID - 10.21037/jtd.2018.06.11 [doi]
PST - ppublish
SO  - J Thorac Dis. 2018 Jun;10(6):3679-3688. doi: 10.21037/jtd.2018.06.11.