What is the clinical evidence from this study?

Study design: Cohort. Population: Infective endocarditis (n=420). Intervention: Type 2 Diabetes Mellitus vs. Non-diabetic patients. Primary outcome: 5-year mortality (HR 1.715, 95% CI 1.056-2.785, p=0.029).

June 30, 2022Open Access

Surgical treatment on infective endocarditis: impact of diabetes on mortality

Key Result

Type 2 diabetes mellitus significantly increased 5-year mortality to 30.9% compared to 16.6% in non-diabetic patients and was an independent predictor of long-term mortality (HR 1.715) after surgery for infective endocarditis.

Study Design

Type

Cohort (n=420)

Multicenter

Structured PICO

Does type 2 diabetes mellitus increase mortality in patients undergoing surgical treatment for infective endocarditis?

Population

420 patients who underwent surgical treatment of infective endocarditis at a large tertiary center in Israel between 2006 and 2020. Group I (non-diabetic, n=326) and Group II (type 2 diabetic, n=94).

Intervention

Type 2 diabetes mellitus (as a risk factor/exposure)

Comparator

Non-diabetic patients

Outcome

Early, intermediate, and long-term mortality (30-day, in-hospital, 1-, 3-, and 5-year mortality)hard clinical

Type 2 diabetes mellitus is an independent predictor of 5-year mortality in patients undergoing surgical treatment for infective endocarditis, primarily driven by cardiovascular deaths.

Main Result

Effect estimate: HR 1.715 (95% CI 1.056-2.785)

Absolute Event Rate: 30.9% vs 16.6%

p-value: p=0.029

Limitations

Retrospective design
Conducted in a single-center cardiac surgery department
Very high-risk patients who were not candidates for surgery were excluded, which might alter survival results
Did not collect information regarding the time interval between diagnosis and surgical intervention

Abstract

BACKGROUND: Type 2 diabetes mellitus (DM) is a frequent co-morbidity among patients suffering from infective endocarditis (IE). The aim of the study was to evaluate the impact of type 2 DM on the early-, intermediate- and long-term mortality of patients who underwent surgical treatment of endocarditis. METHODS: We performed an observational cohort study in the large tertiary center in Israel during 14 years. All data of patients who underwent surgical treatment of endocarditis, performed between 2006 and 2020 were extracted from the departmental database. Patients were divided into two groups: Group I (non-diabetic patients), and Group II (diabetic patients). RESULTS: The study population includes 420 patients. Group I (non-diabetic patients), comprise 326 patients, and Group II (diabetic patients), comprise 94 patients. Mean follow-up duration was 39.3 ± 28.1 months. Short-term, 30-day and in-hospital mortality, also intermediate-term mortality (1- and 3-year) was higher in the DM group compared with the non-DM group, but did not reach statistical significance: 11.7% vs. 7.7%. (p = 0.215); 12.8% vs. 8.3% (p = 0.285); 20.2% vs. 13.2% (p = 0.1) and 23.4% vs. 15.6% (p = 0.09) respectively. Long-term, 5-year mortality was significantly higher in the DM group, compared to the non-DM group: 30.9% vs. 16.6% (p = 0.003). Furthermore, predictors for long-term mortality included diabetes (CI 1.056-2.785, p = 0.029), as demonstrated by regression analysis. CONCLUSIONS: Diabetic patients have trend to increasing mortality at the short- and intermediate period post-surgery for IE, but this is not statistically significant. Survival of diabetic patients deteriorates after more than three years follow surgery. Diabetes is an independent predictor for long-term, 5-year mortality after surgical treatment of endocarditis, regardless of the patients age and comorbidities. Trial registration Ethical Committee of Sheba Medical Centre, Israel on 02.12. 2014, Protocol 4257.

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