title: Mild renal dysfunction on admission is an important prognostic predictor in patients with infective endocarditis: a retrospective single-center study.
abstract: OBJECTIVE
  Infective endocarditis (IE) continues to be associated with high mortality. The aim of the present study was to identify prognostic predictors for short-term mortality in patients with IE.
  
  
  METHODS
  We conducted a retrospective study of 119 consecutive patients with IE (mean age 58±17). Prognostic predictors for mortality at the early phase of admission were determined using a multivariate regression analysis, and a receiver operating characteristic (ROC) analysis was carried out to evaluate the predictive ability.
  
  
  RESULTS
  Eleven of 119 patients died during hospital admission. In this non-survivor group, the clinical parameters at the time of admission, including serum creatinine (Cr), the estimated glomerular filtration rate (eGFR), the red blood cell count, the white blood cell count, the serum CRP level and heart rate, differed significantly from those observed in the survivors (all; p<0.05). According to a logistic regression analysis, an increase in log-serum Cr per one standard deviation (odds ratio=2.18, 95%CI=1.08-4.41) and a decrease in log-eGFR per one standard deviation (odds ratio=0.51, 95%CI=0.26-0.98) were significantly associated with in-hospital death. The area under the ROC curve for serum Cr to predict the outcome was 0.80, the sensitivity was 64% and the specificity was 85% at a cut-off value of 1.16 mg/dL. For eGFR, the area under the ROC curve was 0.77, the sensitivity was 64% and the specificity was 86% at a cut-off value of 47.5 mL/min./1.73 m(2).
  
  
  CONCLUSIONS
  Mild renal dysfunction at the time of admission is an important predictor of early phase mortality in patients with IE.
authors.affiliation: Department of Internal Medicine, Iwate Medical University, Japan. okihagoodman@yahoo.co.jp
authors.forename: Chikahiko
authors.initials: C
authors.lastname: Koeda
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tashiro
authors.forename: Tomonori
authors.initials: T
authors.lastname: Itoh
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Okabayashi
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000401:mortality; D003131:Combined Modality Therapy; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003729:Dental Care; D004696:Endocarditis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005919:Glomerular Filtration Rate; D006349:Heart Valve Diseases / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents; D003404:Creatinine