Acute kidney injury (AKI) is a common complication following cardiac surgery, occurring in 5 to 20% of the patients [2-5]. It has been associated with increased mortality [3,6,7]. Furthermore, AKI has been reported to be associated with poor prognosis in patients with acute http://www.selleckchem.com/products/17-DMAG,Hydrochloride-Salt.html IE [8-10]. There is therefore a need to prevent episodes of post-operative AKI, which may improve the outcome.Patients with IE are typically at risk of kidney injury and their renal function might further be compromised because of cumulative injuries occurring before, during and after surgery. However, there are limited data on the prognosis of AKI in patients with IE undergoing cardiac surgery, and particularly, the risk factors favoring post-operative worsening of renal function in this context are not well-described.
The aim of the present study was to describe the incidence of AKI patients undergoing operation for an acute episode of endocarditis, and to identify the risk factors for post-operative AKI or worsening of renal function in these patients.Materials and methodsPatientsBetween January 2000 and December 2010, all consecutive patients admitted to the H?pital Europ��en Georges Pompidou (Paris, France), an 800-bed university hospital with a dedicated infectious unit specializing in treatment of patients with IE, with the diagnosis of IE according to the modified Duke criteria [11] and who underwent cardiac surgery with cardiopulmonary bypass were included. The study was approved by our local ethical committee (CEERB Paris Nord) and no consent was needed.
The indications for surgery were refractory congestive heart failure, endocarditis-related dysfunction of native or prosthetic valve, uncontrolled infection, perivalvular extension of infection, systemic embolic episode or large vegetation. The patients who died within the first 24 hours following surgery and those who needed pre-operative renal replacement therapy (RRT) for any reason were excluded from the analysis.Data collectionEpidemiological, clinical and biological data were prospectively collected using a standardized case report form. Clinical and epidemiological data collected are presented in Table 1.Table 1Patients�� characteristicsOutcome measureThe main goal of the present study was to identify the risk factors for worsening of renal function during the peri-operative period in patients operated on for an acute episode of IE.
Therefore, the primary outcome measure Carfilzomib was post-operative AKI, defined as the development or the progression of AKI during the seven days following cardiac surgery with cardiopulmonary bypass. Explicitly, post-operative AKI was defined as (1) the development of AKI in patients with normal renal function before surgery, or (2) the progression of AKI when AKI was already present before surgery.