感染性心内膜炎中的急性肾损伤：一项回顾性分析。

Acute kidney injury in infective endocarditis: A retrospective analysis.

机构信息

Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; EA 3064, GIMAP, Jean-Monnet University, University of Lyon, 42000 Saint-Etienne, France; CIC 1408 Inserm, 42055 Saint-Etienne, France.

Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France.

出版信息

Med Mal Infect. 2019 Oct;49(7):527-533. doi: 10.1016/j.medmal.2019.03.015. Epub 2019 Apr 4.

DOI:10.1016/j.medmal.2019.03.015

PMID:30955847

Abstract

BACKGROUND

Acute kidney injury (AKI) is associated with high case fatality in infective endocarditis (IE), but epidemiological data on the frequency of AKI during IE is scarce. We aimed to describe the frequency and risk factors for AKI during the course of IE using Kidney Disease: Improving Global Outcomes consensual criteria.

METHODS

Using the French hospital discharge database (French acronym PMSI), we retrospectively reviewed the charts of 112 patients presenting with a first episode of probable or definite IE between January 2010 and May 2015.

RESULTS

Seventy-seven patients (68.8%) developed AKI. In univariate analysis, risk factors for AKI were cardiac surgery for IE (n=29, 37.7% vs. n=4, 1.4%, P<0.0005), cardiac failure (n=29, 36.7% vs. n=1, 2.9%, P<0.0005), diabetes mellitus (n=14, 18.2% vs. n=1, 0.9%, P=0.034), and prosthetic valve IEs (n=24, 31.2% vs. n=4, 11.4%). No differences were observed for gentamicin exposure (n=57, 64% vs. n=32, 86.5%, P=0.286). Prosthetic valve IE, cardiac failure, and vancomycin exposure were independently associated with AKI with respective odds ratio of 5.49 (95% CI 1.92-17.9), 4.37 (95% CI 4.37-465.7), and 1.084 (1.084-16.2). Mean length of hospital stay was significantly longer in patients presenting with AKI than in controls (respectively 52.4±22.1 days vs. 39.6±12.6, P<0.005).

CONCLUSION

AKI is very frequent during IE, particularly in patients with prosthetic valve IE, cardiac failure, and those receiving vancomycin.

摘要

背景

急性肾损伤（AKI）与感染性心内膜炎（IE）的高病死率相关，但关于 IE 期间 AKI 发生频率的流行病学数据很少。我们旨在使用肾脏病：改善全球预后（KDIGO）共识标准描述 IE 过程中 AKI 的频率和危险因素。

方法

使用法国住院患者数据库（PMSI），我们回顾性分析了 2010 年 1 月至 2015 年 5 月期间首次确诊疑似或明确 IE 的 112 例患者的病历。

结果

77 例患者（68.8%）发生 AKI。单因素分析显示，IE 心脏手术（n=29，37.7%比 n=4，1.4%，P<0.0005）、心力衰竭（n=29，36.7%比 n=1，2.9%，P<0.0005）、糖尿病（n=14，18.2%比 n=1，0.9%，P=0.034）和人工瓣膜 IE（n=24，31.2%比 n=4，11.4%）是 AKI 的危险因素。庆大霉素暴露（n=57，64%比 n=32，86.5%，P=0.286）无差异。人工瓣膜 IE、心力衰竭和万古霉素暴露与 AKI 独立相关，优势比分别为 5.49（95%CI 1.92-17.9）、4.37（95%CI 4.37-465.7）和 1.084（1.084-16.2）。发生 AKI 的患者的住院时间明显长于对照组（分别为 52.4±22.1 天和 39.6±12.6 天，P<0.005）。