Outcome of dialysis-requiring acute kidney injury in patients with infective endocarditis: A nationwide study

2020 ◽  
Author(s):  
Jeppe Kofoed Petersen ◽  
Andreas Dalsgaard Jensen ◽  
Niels Eske Bruun ◽  
Anne-Lise Kamper ◽  
Jawad Haider Butt ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Valve Surgery ◽  
Cardiac Valve ◽  
Post Discharge ◽  
Dialysis Treatment ◽  
Cardiac Valve Surgery ◽  
One Year

Abstract Background Infective endocarditis (IE) may be complicated by acute kidney injury, yet data on the use of dialysis and subsequent reversibility are sparse. Methods Using Danish nationwide registries, we identified patients with first-time IE from 2000 to 2017. Dialysis naïve patients were grouped into: those with and those without dialysis during admission with IE. Continuation of dialysis was followed one year post-discharge. Multivariable adjusted Cox proportional hazard analysis was used to examine one-year mortality for patients surviving IE according to use of dialysis. Results We included 7,307 patients with IE; 416 patients (5.7%) initiated dialysis treatment during admission with IE and these were younger, had more comorbidities and more often underwent cardiac valve surgery compared with non-dialysis patients (47.4% vs. 20.9%). In patients with both cardiac valve surgery and dialysis treatment (n=197), 153 (77.7%) initiated dialysis on- or after the date of surgery. The in-hospital mortality was 40.4% and 19.0% for patients with and without dialysis, respectively (p<0.0001). Of those who started dialysis and survived hospitalization, 21.6% continued dialysis treatment within one year after discharge. In multivariable adjusted analysis, dialysis during admission with IE was associated with an increased one-year mortality from IE discharge, HR=1.64 (95% CI: 1.21-2.23). Conclusion In dialysis-naïve patients with IE, approximately 1 in 20 patients initiated dialysis treatment during admission with IE. Dialysis identified a high-risk group with an in-hospital mortality of 40% and an approximately 20% risk of continued dialysis. Those with dialysis during admission with IE showed worse long-term outcomes than those without.

scholarly journals Assessment of acute kidney injury risk using a machine-learning guided generalized structural equation model: a cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wen En Joseph Wong ◽  
Siew Pang Chan ◽  
Juin Keith Yong ◽  
Yen Yu Sherlyn Tham ◽  
Jie Rui Gerald Lim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Hospital Mortality ◽  
Structural Equation Model ◽  
Structural Equation ◽  
Injury Risk ◽  
Kidney Injury ◽  
Equation Model ◽  
Surgical Icu ◽  
One Year

Abstract Background Acute kidney injury is common in the surgical intensive care unit (ICU). It is associated with poor patient outcomes and high healthcare resource usage. This study’s primary objective is to help identify which ICU patients are at high risk for acute kidney injury. Its secondary objective is to examine the effect of acute kidney injury on a patient’s prognosis during and after the ICU admission. Methods A retrospective cohort of patients admitted to a Singaporean surgical ICU between 2015 to 2017 was collated. Patients undergoing chronic dialysis were excluded. The outcomes were occurrence of ICU acute kidney injury, hospital mortality and one-year mortality. Predictors were identified using decision tree algorithms. Confirmatory analysis was performed using a generalized structural equation model. Results A total of 201/940 (21.4%) patients suffered acute kidney injury in the ICU. Low ICU haemoglobin levels, low ICU bicarbonate levels, ICU sepsis, low pre-ICU estimated glomerular filtration rate (eGFR) and congestive heart failure was associated with the occurrence of ICU acute kidney injury. Acute kidney injury, together with old age (> 70 years), and low pre-ICU eGFR, was associated with hospital mortality, and one-year mortality. ICU haemoglobin level was discretized into 3 risk categories for acute kidney injury: high risk (haemoglobin ≤9.7 g/dL), moderate risk (haemoglobin between 9.8–12 g/dL), and low risk (haemoglobin > 12 g/dL). Conclusion The occurrence of acute kidney injury is common in the surgical ICU. It is associated with a higher risk for hospital and one-year mortality. These results, in particular the identified haemoglobin thresholds, are relevant for stratifying a patient’s acute kidney injury risk.

scholarly journals 155. Infective Endocarditis and Cardiac Valve Surgery During the Opioid Epidemic in North Carolina, 2007 to 2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S12-S12
Author(s):  
Asher Schranz ◽  
Aaron Fleischauer ◽  
Vivian H Chu ◽  
David Rosen
Keyword(s):  
North Carolina ◽  
Infective Endocarditis ◽  
Drug Use ◽  
Fold Increase ◽  
International Classification Of Diseases ◽  
Valve Surgery ◽  
Cardiac Valve ◽  
Hospital Charges ◽  
Opioid Epidemic ◽  
Cardiac Valve Surgery

Abstract Background Infective endocarditis (IE) associated with drug use (DA-IE) is rising nationally. North Carolina (NC), a state hard-hit by the opioid epidemic, saw an over 12-fold increase in DA-IE from 2010 to 2015. Concerns about surgery exist due to the risk of ongoing drug use and reinfection after valvuloplasty. We evaluated trends, characteristics, and outcomes of valve surgery for DA-IE, compared with IE not associated with drug use (non-DA-IE), in NC. Methods We analyzed the NC Discharge Database, which includes administrative data from all hospital discharges in NC. Using International Classification of Diseases codes, we identified all persons ≥18 years of age with IE from July 1, 2007 to June 30, 2017. Hospitalizations were deemed DA-IE by a diagnosis code related to illicit drug use, dependence, poisoning or withdrawal (excepting marijuana), or Hepatitis C in a person born after 1965. All others were labeled non-DA-IE. Procedure codes were queried to identify cardiac valve surgery. Year-to-year trends in surgery for IE by drug-associated status were reported. Demographics, length of stay (LOS), charges, and disposition were compared among DA-IE and non-DA-IE. Results A total of 22,809 hospitalizations were coded for IE. Valve surgery occurred in 1,652. Of surgical hospitalizations, 17% overall and 42% in the final study year were DA-IE. Hospitalizations for DA-IE where surgery was done increased from <10 through 2012–2013 to 109 in 2016–2017 (figure). Compared with non-DA-IE, those undergoing surgery for DA-IE were younger (median age 33 vs. 56), female (47% vs. 33%), White (89% vs. 64%), uninsured (34% vs. 11%), insured by Medicaid (39% vs. 13%), and had tricuspid valve surgery (38% vs. 11%). DA-IE had longer median LOS (27 vs. 17 days) and were less often discharged home (51% vs. 59%). For the 287 DA-IE admissions with surgery, median hospital charges were $247,524, totaling over $79,000,000. All comparisons were significant at P < 0.0001. Conclusion From 2007 to 2017, valve surgeries for DA-IE in NC rose over tenfold and are approaching half of all surgeries for IE. This phenomenon is an underappreciated and morbid component of the opioid epidemic that burdens hospital and state resources. Research into best practices for managing patients with DA-IE and addressing addiction in this setting is critically needed. Disclosures All authors: No reported disclosures.

scholarly journals Acute Kidney Injury and In-Hospital Mortality: A Retrospective Analysis of a Nationwide Administrative Database of Elderly Subjects in Italy

2019 ◽  
Vol 8 (9) ◽  
pp. 1371 ◽  
Author(s):  
Fabbian ◽  
Savriè ◽  
De Giorgi ◽  
Cappadona ◽  
Di Simone ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
International Classification Of Diseases ◽  
Administrative Database ◽  
Elderly Subjects ◽  
Dialysis Treatment ◽  
The Third ◽  
Classification Of Diseases

Background: The aim of this study was to investigate the association between acute kidney injury (AKI) and in-hospital mortality (IHM) in a large nationwide cohort of elderly subjects in Italy. Methods: We analyzed the hospitalization data of all patients aged ≥65 years, who were discharged with a diagnosis of AKI, which was identified by the presence of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), and extracted from the Italian Health Ministry database (January 2000 to December 2015). Data regarding age, gender, dialysis treatment, and comorbidity, including the development of sepsis, were also collected. Results: We evaluated 760,664 hospitalizations, the mean age was 80.5 ± 7.8 years, males represented 52.2% of the population, and 9% underwent dialysis treatment. IHM was 27.7% (210,661 admissions): Deceased patients were more likely to be older, undergoing dialysis treatment, and to be sicker than the survivors. The population was classified on the basis of tertiles of comorbidity score (the first group 7.48 ± 1.99, the second 13.67 ± 2,04, and third 22.12 ± 4.13). IHM was higher in the third tertile, whilst dialysis-dependent AKI was highest in the first. Dialysis-dependent AKI was associated with an odds ratios (OR) of 2.721; 95% confidence interval (CI) 2.676–2.766; p < 0.001, development of sepsis was associated with an OR of 1.990; 95% CI 1.948–2.033; p < 0.001, the second tertile of comorbidity was associated with an OR of 1.750; 95% CI 1.726–1.774; p < 0.001, and the third tertile of comorbidity was associated with an OR of 2.522; 95% CI 2.486–2.559; p < 0.001. Conclusions: In elderly subjects with AKI discharge codes, IHM is a frequent complication affecting more than a quarter of the investigated population. The increasing burden of comorbidity, dialysis-dependent AKI, and sepsis are the major risk factors.

scholarly journals Sex Differences in the Utilization and Outcomes of Cardiac Valve Replacement Surgery for Infective Endocarditis: Insights From the National Inpatient Sample

2021 ◽  
Author(s):  
Agam Bansal ◽  
Paul C. Cremer ◽  
Wael A. Jaber ◽  
Penelope Rampersad ◽  
Venu Menon
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Valve Surgery ◽  
Cardiac Valve ◽  
National Inpatient Sample ◽  
Men And Women ◽  
Replacement Surgery ◽  
Cardiac Valve Replacement ◽  
Valve Replacement Surgery

Background The data on the differential impact of sex on the utilization and outcomes of valve replacement surgery for infective endocarditis are limited to single‐center and small sample size patient population. Methods and Results We utilized the National Inpatient Sample database to identify patients with a discharge diagnosis of infective endocarditis from 2004 to 2015 to assess differences in the characteristics and clinical outcomes of patients hospitalized with infective endocarditis stratified by sex. We also evaluated trends in utilization of cardiac valve replacement and individual valve replacement surgeries in women versus men over a 12‐year period, and compared in‐hospital mortality after surgical treatment in women versus men. A total of 81 942 patients were hospitalized with a primary diagnosis of infective endocarditis from January 2004 to September 2015, of whom 44.31% were women. Women were less likely to undergo overall cardiac valve replacement (6.92% versus 12.12%), aortic valve replacement (3.32% versus 8.46%), mitral valve replacement (4.60% versus 5.57%), and combined aortic and mitral valve replacement (0.85% versus 1.81%) but had similar in‐hospital mortality rates. From 2004 to 2015, the overall rates of cardiac valve replacement increased from 11.76% to 13.96% in men and 6.34% to 9.26% in women and in‐hospital mortality declined in both men and women. Among the patients undergoing valve replacement surgery, in‐hospital mortality was higher in women (9.94% versus 6.99%, P <0.001). Conclusions Despite increased utilization of valve surgery for infective endocarditis in both men and women and improving trends in mortality, we showed that there exists a treatment bias with underutilization of valve surgeries for infective endocarditis in women and demonstrated that in‐hospital mortality was higher in women undergoing valve surgery in comparison to men.

Risk Index for Predicting In-Hospital Mortality for Cardiac Valve Surgery

2007 ◽  
Vol 83 (3) ◽  
pp. 921-929 ◽  
Author(s):  
Edward L. Hannan ◽  
Chuntao Wu ◽  
Edward V. Bennett ◽  
Russell E. Carlson ◽  
Alfred T. Culliford ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Risk Index ◽  
Valve Surgery ◽  
Cardiac Valve ◽  
Cardiac Valve Surgery

scholarly journals Prognosis of short- and long-term dialysis in patients with infective endocarditis: a nationwide study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Petersen ◽  
A.D Jensen ◽  
N.E Bruun ◽  
A Kamper ◽  
J.W Butt ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Dialysis Patients ◽  
Term Survival ◽  
Dialysis Treatment ◽  
Increased Risk ◽  
Short And Long Term ◽  
Continued Use ◽  
One Year

Abstract Background Infective endocarditis (IE) may be complicated by acute kidney injury, yet data on the use of dialysis and subsequent reversibility are sparse. We set out to examine the prognosis of short- and long-term dialysis in patients with IE. Methods Using Danish nationwide registries we identified patients with first-time IE from 2000 to 2017. Dialysis naïve patients were grouped into: those who were treated with dialysis during admission with IE and those who were not. The cumulative incidence of continuous use of dialysis was examined one year post-discharge Multivariable adjusted Cox proportional hazard analysis was used to examine one-year mortality for patients surviving IE based on use of dialysis. Results We included 7,307 patients with IE; 416 patients (5.7%) initiated dialysis treatment during admission with IE and these were younger, had more comorbidities and more often underwent cardiac valve surgery during admission with IE compared with non-dialysis patients (47.4% vs. 20.9%). In patients with both surgical intervention and dialysis treatment, 153 (77.7%) initiated dialysis on- or after the date of surgery. The in-hospital mortality was 40.4% and 19.0% for patients with and without dialysis, respectively (p&lt;0.0001). Of those who started dialysis and survived hospitalisation, 78.4% became dialysis-free within one year after discharge. Among those who survived one week subsequent to IE discharge, we identified 5,520 who never had dialysis, 204 patients without continued use of dialysis, and 40 patients with a continued use of dialysis. The corresponding mortality risk at one year was 15.2%, 13.5%, and 41.6% (Figure), respectively. Compared with patients not treated with dialysis, those who became dialysis-free at discharge showed no increased risk of one year mortality in adjusted analysis (HR=1.45, 95% CI: 0.97–2.20), while patients who continued dialysis had an increased associated risk of mortality (HR=2.00, 95% CI: 1.20–3.33). Conclusion In dialysis-naïve patients with IE, more than 1 in 20 patients initiated dialysis treatment during admission. Dialysis identified a high-risk group with an in-hospital mortality of 40%–twice as high as their counterparts. In dialysis patients surviving admission with IE, almost 80% became dialysis-free and showed better long-term survival than those who continued dialysis after discharge. Figure 1 Funding Acknowledgement Type of funding source: None

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