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Predicting acute kidney injury in patients with infective endocarditis: the AKI-IE Score
Session:
Sessão de Posters 24 - Endocardite infeciosa: estratificação de risco, tratamento e desfechos
Speaker:
João Gouveia Fiuza
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.2 Infective Endocarditis – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
João Gouveia Fiuza; Gonçalo RM Ferreira; Mariana Duarte Almeida; Francisco Rodrigues dos Santos; Oliver Kungel; Luís Afonso Santos; Júlio Gil; António Costa
Abstract
<p><strong>Introduction:</strong> Acute kidney injury (AKI) affects a significant proportion of patients with infective endocarditis (IE) and is associated with increased mortality. Early identification of high-risk patients could enable targeted preventive strategies.</p> <p><br /> <strong>Purpose: </strong>To determine the prevalence of AKI in IE, identify baseline predictors, and develop a simple risk stratification score.</p> <p><br /> <strong>Methods:</strong> Retrospective single-centre cohort of 64 consecutive patients with blood culture-positive IE over a 5-year period. AKI was defined by KDIGO criteria. Baseline variables included demographics, comorbidities, risk scores and laboratory parameters. Multivariable logistic regression identified independent predictors. A simplified risk score was derived.</p> <p><br /> <strong>Results: </strong>Mean age was 69±12 years, 67% male. AKI occurred in 42 patients (65.6%). In-hospital mortality (IHM) was 25%. Patients with AKI were significantly older (72±12 vs. 62±9 years, p<0.001), had higher qSOFA (1.1±1.0 vs. 0.1±0.4, p<0.001), SOFA (5.1±3.5 vs. 2.8±2.1, p=0.007) and SHARPEN scores (11.4±2.0 vs. 8.4±1.9, p<0.001), and more often had prior heart failure (40.5% vs. 13.6%, p=0.045).</p> <p>Baseline creatinine, echocardiographic parameters, white blood cell and platelet counts, liver enzymes and vegetation size were similar between groups. In multivariable analysis, independent predictors were age (OR 1.11 per year, p=0.005) and qSOFA (OR 8.51 per point, p=0.008). Prior heart failure was not independently associated with AKI (OR 3.04, p=0.205).</p> <p>The AKI-IE Score incorporated age ≥70 years (1 point), prior heart failure (1 point; retained for clinical relevance and consistency with its univariable association) and qSOFA ≥1 (2 points). In this cohort, observed scores ranged from 0 to 3 points. The score demonstrated excellent discrimination (area under the curve 0.854, p<0.001) and stratified patients into three risk groups: low risk (score 0, 12% AKI incidence, n=17), high risk (score 1, 81% incidence, n=21; and score 2, 82% incidence, n=17) and very high risk (score 3, 100% incidence, n=9). For identifying patients requiring intensified prevention (score ≥2), specificity was 86% and positive predictive value 88%, with sensitivity 55%.</p> <p>IHM was higher in patients with AKI (33.3% vs. 9.1%, OR 5.0, p=0.038).</p> <p><br /> <strong>Conclusion: </strong>AKI affects two-thirds of IE patients and confers a 5-fold increase in IHM. The AKI-IE Score uses three readily available baseline variables to stratify patients into three distinct risk groups. This simple tool may support rational allocation of preventive measures and intensive monitoring to high-risk patients.<br /> </p>
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