Insulin-treated diabetes mellitus was an independent predictor of in-hospital mortality in patients with infective endocarditis (OR 4.69; 95% CI 1.77-12.44), whereas oral-treated diabetes was not.
Observational (n=559)
Does insulin-treated diabetes mellitus increase in-hospital mortality in patients with infective endocarditis compared to oral antidiabetic-treated or non-diabetic patients?
Insulin-treated diabetes is a strong independent predictor of in-hospital mortality in patients with infective endocarditis, likely driven by higher rates of staphylococcal infection.
Effect estimate: OR 4.69 (95% CI 1.77-12.44)
Absolute Event Rate: 50% vs 15%
p-value: p=<0.001
AIMS: To analyse the characteristics of infective endocarditis (IE) in patients with diabetes mellitus (DM), and to evaluate the prognostic significance of DM according to insulin use. METHODS AND RESULTS: A total of 559 patients with definite IE including 75 patients (13%) with DM (insulin use n = 22; oral antidiabetic n = 53) were evaluated. Comparison of insulin-DM, oral-DM, and non-DM patients showed an older age (66 +/- 13, 66 +/- 10, 58 +/- 17, respectively; P = 0.004) in DM patients, and more frequent IE on prosthetic valves (32, 11, and 15%, respectively; P = 0.068) in insulin-DM patients. Oral streptococci (0, 8, and 18%, respectively; P = 0.016) were less frequently the causative organism than staphylococci (64, 26, and 29%, respectively; P = 0.002) in insulin-DM patients. Vegetations, dehiscence, abscess, and regurgitation rates did not differ among the three groups, nor did cardiac surgery rates (32, 47, and 48%, respectively; P = 0.334), but in-hospital mortality was higher in insulin-DM patients (50, 19, and 15%; P < 0.001). In multivariable analysis, independently of other determinants of death (age, IE location, Staphylococcus aureus, history of heart failure, immunosuppression, creatinine serum), insulin-DM was a predictor of death (OR, 4.69; 95% CI, 1.77-12.44), whereas oral-DM was not. CONCLUSION: IE prognosis in insulin-DM patients is poor due to the coexistence of host and pathogen factors. Insulin-DM patients with IE may require specific management.
Duval et al. (Tue,) conducted a observational in Infective endocarditis and diabetes mellitus (n=559). Insulin-treated diabetes mellitus vs. Oral-treated diabetes mellitus and non-diabetes mellitus was evaluated on In-hospital mortality (OR 4.69, 95% CI 1.77-12.44, p=<0.001). Insulin-treated diabetes mellitus was an independent predictor of in-hospital mortality in patients with infective endocarditis (OR 4.69; 95% CI 1.77-12.44), whereas oral-treated diabetes was not.