vonTokarski et al identified risk factors for early acute kidney injury in a patient with infective endocarditis. These can help to identify a patient whose renal function should be more closely monitored. The authors are from multiple institutions in France.
Patient selection: infective endocarditis
Outcome: early acute kidney injury (AKI) during the first week after admission. AKI is defined as a rise in serum creatinine by 26.5 µmol/L within 48 hours OR a serum creatinine 1.5 times baseline OR acute renal replacement therapy
Risk factors for early AKI:
(1) infective endocarditis due to Staphylococcus aureus (OR 3.4)
(2) history of diabetes mellitus (OR 2.3)
(3) peripheral arterial disease (OR 2.6)
(4) immunological manifestations (OR 3.1; arthralgias, Roth spots or splinter hemorrhages)
(5) use of norepinephrine (OR 3.4)
where:
• Norepinephrine was the only pressor use mentioned but hypotension requiring pressor therapy is probably an equivalent risk factors.
Additional risk factors from univariate analysis:
(1) 2 or more nephrotoxic drugs
(2) congestive heart failure or acute heart failure
(3) glycopeptide/vancomycin therapy
The presence of early AKI is associated with increased hospital mortality and chronic kidney disease progression.
