The relationship between albuminuria and poor clinical outcomes in patients with infective endocarditis.

BACKGROUND: We explored the impact of albuminuria on clinical outcomes in patients with infective endocarditis (IE). METHODS: Patients with IE were prospectively enrolled and divided into 3 groups based on albuminuria measured by qualitative dipstick at admission and were followed up for 1y. Univariate and multivariate analysis were performed to evaluate the relationship between albuminuria and mortality. RESULTS: Nine-hundred seventy patients were divided into 3 groups: negative (urine dipstick negative) (n=694), trace (urine dipstick trace) (n=150) and positive (urine dipstick≥1+ protein) (n=126). In-hospital mortality increased with increasing albuminuria (5.2%, 8.0% and 17.5%, p<0.001, for the negative, trace, and positive groups, respectively). Compared with negativity for albuminuria, positivity for albuminuria was an independent risk predictor for in-hospital death (OR=2.79, 95% CI=1.41-5.49; p=0.003). The cumulative rate of one-year mortality was higher among albuminuria-positive patients than among albuminuria-negative patients. Multivariate Cox analysis demonstrated that albuminuria positivity was associated with one-year mortality (HR=1.89, 95% CI=1.17-3.04, p=0.010). CONCLUSION: Albuminuria was independently associated with in-hospital death in IE patients. Urine dipstick≥1+ protein was linked to increased one-year mortality. As a simple and inexpensive marker, albuminuria measured by qualitative dipstick might be helpful for risk stratification in IE.

The clinical manifestations of infective endocarditis.

Frequently, the presence of endocarditis is disguised. The emphasis of this description of the clinical manifestations of endocarditis is on the various modes of presentation, rather than on individual symptoms and signs. Endocarditis can manifest with cardiac, pulmonary, ophthalmic, central nervous system, renal, orthopedic, phthisic, and peripheral vascular disorders. The following clinical data are most useful in helping to establish a diagnosis of endocarditis: a history of fever, anorexia, weight loss, and back pain; a search for petechiae; splenomegaly; and daily examination, especially cardiac auscultation and funduscopic examination, of those patients in whom incomplete evidence exists at admission. The most helpful laboratory tests include those revealing anemia, increased erythrocyte sedimentation rate, abnormalities in the urine compatible with nephritis, or embolization. In patients who have not received antimicrobial therapy just before the diagnostic workup, one set of three blood cultures is sufficient to isolate the offending microorganism in about 95% of cases.