European Heart Journal Advance Access originally published online on October 13, 2006
European Heart Journal 2007 28(1):59-64; doi:10.1093/eurheartj/ehl318
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Diabetes mellitus and infective endocarditis: the insulin factor in patient morbidity and mortality
1 Université Paris 7, Denis Diderot, Laboratoire de pathologie Infectieuse, Paris, France
2 AP-HP Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, 46 rue Henri Huchard, 75877 Paris, Cedex 18, France
3 Inserm, U738 Paris, France
4 Centre hospitalier Universitaire, Nancy, France
5 Centre hospitalier Universitaire, Guy de Chauliac, Montpellier, France
6 Centre hospitalier Universitaire, Lyon, France
7 Université Paris-Descartes, Faculté de Médecine, Paris, France
8 AP-HP Hôpital Européen Georges Pompidou, Paris, France
9 Centre hospitalier Universitaire, Besançon, France
Received 6 March 2006; revised 14 September 2006; accepted 28 September 2006; online publish-ahead-of-print 13 October 2006.
* Corresponding author. Tel: +33 1 40 25 78 03; fax: +33 1 40 25 88 60. E-mail address: xavier.duval{at}bch.aphp.fr
See page 3 for the editorial comment on this article (doi:10.1093/eurheartj/ehl377)
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.
Key Words: Infective endocarditis • Diabetes mellitus • Insulin • Staphylococcus aureus • Prognostic factors • Death
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