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Clinical Characteristics Of Infective Endocarditis Patients With Acute Kidney Injury And ANCA Positive

Posted on:2024-02-21Degree:MasterType:Thesis
Country:ChinaCandidate:Z Y WangFull Text:PDF
GTID:2544306923457294Subject:Internal Medicine
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Background and objectiveInfective endocarditis(IE)is an inflammation of the heart valves or endocardium of the ventricular wall caused by infection with bacteria,fungi and other pathogenic microorganisms.It is associated with a high mortality.Acute kidney injury(AKI)is a common complication of IE and associated with high mortality.Antineutrophil cytoplasmic antibody(ANCA)is a diagnostic marker for ANCA-associated vasculitis(AAV).However,serologic ANCA has been detected in patients with a variety of infectious diseases,particularly IE.At present,the study of IE with AKI and ANCA-positive were mostly of case reports.The purpose of this study is to summarize the clinical characteristics of IE patients with AKI,to preliminarily explore the risk factors for AKI of IE patients,and the relationship between ANCA and AKI in IE,in order to improve the clinical diagnosis and treatment.MethodsWe retrospectively analyzed the IE patients hospitalized in Qilu Hospital of Shandong University from June 1,2012 to June 1,2022.The patients were divided into AKI group and non-AKI group.In order to study the clinical characteristics and identify the risk factors for AKI in IE patients,the demographic characteristics,clinical features,laboratory and histopathological results were collected and analyzed.The IE patients with ANCA were also divided into AKI group and non-AKI group.The ANCA positive ratios of IE with AKI or non-AKI groups were analyzed;The patients with ANCA positive were also divided into ANCA positive and negative group.The relationship between ANCA and AKI of IE patients was analyzed.Kaplan-Meier method was used to draw the survival curves of AKI group and non-AKI group,ANCA positive and negative group.The survival differences of different groups were compared by Log-rank test.Results1.346 patients with IE were divided into AKI group and non-AKI group according to AKI diagnostic criteria of KDIGO 2021 guidelines.The results of univariate analysis of each variable between groups showed that patients were older(P=0.029)and more male patients in the AKI group(P=0.037);Compared with the non-AKI group,the AKI group had more patients with diabetes mellitus(P=0.015),hypertension(P=0.014),and higher proportion of deaths(P=0.031);Patients had higher level of serum creatinine,blood urea nitrogen,uric acid,triglycerides,urine erythrocyte and proteinuria(P<0.001),aspartate aminotransferase(P=0.040),low-density lipoprotein cholesterol(P=0.021),and neutrophil percentage(P=0.003);eGFR(P<0.001),number of erythrocyte(P=0.020),and more multiple valve involvement in the AKI group(P=0.004).2.103 patients with ANCA testing were divided into AKI group and non-AKI group.Analysis showed that patients had higher ratio of ANCA positivity(P=0.011)and a predominance of PR3-ANCA positivity in the AKI group(P=0.021).Multifactor logistic regression equation showed that male,hypertension,ANCA positive,and low level of albumin were independent risk factors of AKI in IE patients.3.AKI patients had a shorter survival time compared to non-AKI patients(P<0.001).Conclusion1.In the IE with AKI group,patients were older and more male;In addition,more patients combined with diabetes mellitus and hypertension,and higher percentage of deaths;Meanwhile,patients had higher levles of urine erythrocyte sedimentation rate and proteinuria;The level of serum creatinine,blood urea nitrogen,uric acid,triglycerides,aspartate transaminase,low-density lipoprotein cholesterol,and neutrophil percentage were higher;While eGFR,number of red blood cell,the level of hemoglobin and albumin were lower;Multivalvular lesions were more common.2.AKI associated with higher mortality in IE patients.This study shown that male,hypertension,ANCA positive and lower level of albumin were independent risk factors for the AKI in IE patients.3.None of the ANCA-positive IE patients in this study met the diagnostic criteria for AAV.ANCA positivity may be involved in the development of kidney injury.4.The survival time of IE patients with AKI was significantly shorter.Positive ANCA had no significant effect on the survival time of IE patients.
Keywords/Search Tags:infective endocarditis, acute kidney injury, antineutrophil cytoplasmic antibody, risk factors, survival analysis
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