Risk factors of infective endocarditis-associated acute kidney injury: benefits of low-dose amikacin and surgery.

Annals of medicine Pub Date : 2025-12-01 Epub Date: 2025-03-25 DOI:10.1080/07853890.2025.2482023

SanXi Ai, XinPei Liu, Nan Zhao, Qi Miao, Yan Qin, XueMei Li

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Abstract

Objective: Acute kidney injury (AKI) is a frequent presentation in patients with infective endocarditis (IE), and is associated with poor outcomes. The primary aim of the study was to determine the risk factors for AKI in patients with IE.

Methods: A retrospective study was conducted in a tertiary hospital in China from August 2012 to April 2022. The primary outcome was AKI. Logistic regression was used to identify risk factors for AKI.

Results: A total of 594 patients with IE were included, of which 256 (43.1%) experienced AKI. The following variables were found to be independent risk factors for AKI: hypertension (OR 1.96, p = 0.011), Staphylococcus aureus infection (OR 2.69, p = 0.008), heart failure (OR 5.99, p < 0.001), shock (OR 5.93, p = 0.015) and hematuria (OR 2.38, p < 0.001). The use of low-dose amikacin (400 mg daily) was associated with a lower incidence of AKI (OR 0.38, p < 0.001). Among patients with IE complicated by heart failure, surgery was associated with a lower incidence of AKI (OR 0.21, p = 0.010).

Conclusion: AKI is common in IE. Hypertension, Staphylococcus aureus infection, heart failure, shock and hematuria are risk factors of IE-associated AKI, whereas low-dose amikacin is a protective factor. Surgery is a protective factor of AKI in the setting of IE complicated by heart failure.

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Annals of medicine

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