Abstract: SA-PO017

Incidence and Costs of AKI in Hospitalized Patients with Infective Endocarditis

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Donaldson, Katherine Michele, University of Kentucky, Lexington, Kentucky, United States
  • Rudy, Mark, University of Kentucky, Lexington, Kentucky, United States
  • Cleland, Daniel E, University of Kentucky, Lexington, Kentucky, United States
  • Du, Gaixin, UKY, Lexington, Kentucky, United States
  • Huaman, Moises A, University of Cincinnati, Cincinnati, Ohio, United States
  • Thornton, Alice, University of Kentucky, Lexington, Kentucky, United States
  • Fanucchi, Laura, University of Kentucky, Lexington, Kentucky, United States
  • Neyra, Javier A., University of Kentucky Medical Center, Lexington, Kentucky, United States
Background

Acute kidney injury (AKI) is a frequent complication of hospitalized patients with infective endocarditis (IE) and carries adverse outcome. We examined the incidence, costs and characteristics associated with AKI in hospitalized patients with IE.

Methods

Retrospective cohort study of patients with IE admitted to UK hospital from 1/2013 to 12/2015. IE was defined by the modified Duke criteria. AKI was defined by the serum creatinine-KDIGO criteria. Patients with end-stage renal disease, kidney transplant, or baseline eGFR<15 were excluded. Multivariable logistic regression analysis of AKI as the dependent variable was used.

Results

297 patients were included in the analysis. Of these, 40.4% were women and 94.9% were white. Mean age (SD) was 45.2 (16.3) years. AKI occurred in 186 (66.0%) patients: 54 (29.0%) developed AKI within the first 72 h and 132 (71.0%) after 72 h of admission. AKI was more common in women than in men (70.8% vs 57.0%, p=0.016). Hospital mortality in patients with AKI was 18.8% vs 14.4% in those without AKI, p=0.33. Patients who developed AKI had a longer hospital stay: median (IQR) 30 (15–47) vs 9 (5–18) days, p<0.001. AKI occurred more often in patients of poor socioeconomic status, with a diagnosis of hepatitis B and C or bacteremia, with exposure to aminoglycosides or diuretics and with a history of recurrent IE (all p<0.01). The median total direct cost of hospitalization in those with AKI vs without AKI was $51,488 (23,325–73,985) vs $14,801 (6,722–31,910), p<0.001. Female gender (OR 1.77, 95% CI 1.03–3.07), hepatitis C diagnosis (OR 1.98, 1.15–3.41) and comorbidity risk of mortality score=4 (OR 4.51, 2.64-7.69) were independently associated with incident AKI.

Conclusion

Two out of three hospitalized patients with IE develop AKI. Most episodes of AKI occurred after 72 h of hospital admission. Patients with AKI had a longer hospital stay, incurring higher total direct costs. Female gender, hepatitis C diagnosis and risk of mortality score=4 were independently associated with the occurrence of AKI in this susceptible population.

Funding

  • Other NIH Support