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European Heart Journal Advance Access published online on October 13, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl318
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received March 6, 2006
Revised September 14, 2006
Accepted September 28, 2006

Clinical research

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

Xavier Duval 1 *, François Alla 2, Thanh Doco-Lecompte 2, Vincent Le Moing 3, François Delahaye 4, Jean-Luc Mainardi 5, Patrick Plesiat 6, Marie Célard 4, Bruno Hoen 6, and Catherine Leport 7, for the Association pour l'Etude et la Prévention de l'Endocardite Infectieuse (AEPEI)

1 Université Paris 7, Denis Diderot, Laboratoire de pathologie Infectieuse, Paris, France; AP-HP Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, 46 rue Henri Huchard, 75877 Paris, Cedex 18, France; Inserm, U738 Paris, France
2 Centre hospitalier Universitaire, Nancy, France
3 Centre hospitalier Universitaire, Guy de Chauliac, Montpellier, France
4 Centre hospitalier Universitaire, Lyon, France
5 Université Paris-Descartes, Faculté de Médecine, Paris, France; AP-HP Hôpital Européen Georges Pompidou, Paris, France
6 Centre hospitalier Universitaire, Besançon, France
7 Université Paris 7, Denis Diderot, Laboratoire de pathologie Infectieuse, Paris, France; AP-HP Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, 46 rue Henri Huchard, 75877 Paris, Cedex 18, France

* To whom correspondence should be addressed.
Xavier Duval, E-mail: xavier.duval{at}bch.aphp.fr


  Abstract

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.

Keywords: Infective endocarditis; Diabetes mellitus; Insulin; Staphylococcus aureus; Prognostic factors; Death.
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