Diabetes mellitus and infective endocarditis: the insulin factor in patient morbidity and mortality.
OBJECTIVE
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.


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.


CONCLUSIONS
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
Xavier
X
Université Paris 7, Denis Diderot, Laboratoire de pathologie Infectieuse, Paris, France. xavier.duval@bch.aphp.fr
Alla
François
F
Doco-Lecompte
Thanh
T
Le Moing
Vincent
V
Delahaye
François
F
Mainardi
Jean-Luc
JL
Plesiat
Patrick
P
Célard
Marie
M
Hoen
Bruno
B
Leport
Catherine
C
D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000401:mortality*; D004697:Endocarditis, Bacterial / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies
D007004:Hypoglycemic Agents; D007328:Insulin