Diabetes raises risk for poor outcome in patients with infective endocarditis

  • Benvenga RM & al.
  • PLoS ONE
  • 1 Jan 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with infective endocarditis (IE), diabetes mellitus (DM) was associated with a higher prevalence of vegetations, anatomic complications and impaired left ventricular ejection fraction (LVEF).
  • Patients with DM had significantly higher mortality both in hospital and at long-term.

Why this matters

  • There is no clarity regarding the prognostic impact of DM in terms of morbidity and mortality in patients with IE.

Study design

  • Retrospective analysis of 375 patients with a diagnosis of IE.
  • Primary outcome: risk for all-cause death at long-term follow-up.
  • Secondary outcome: risk for in-hospital mortality.
  • Funding: None

Key results

  • Of 375 patients with IE, 129 (34.4%) were diagnosed with diabetes.
  • Patients with diabetes vs those without had a higher incidence of paravalvular complications (82% vs 64%; P<.001 and a lower incidence of lvef vs p=".001).</li">
  • Risk for in-hospital mortality was higher in patients with diabetes vs those without diabetes (84% vs 74%; P=.030).
  • In logistic regression analysis, history of heart failure (OR, 3.12; 95% CI, 1.64-5.95) and low value of LVEF (OR, 0.96; 95% CI, 0.93-0.98; P=.001 for both) were independent predictors of in-hospital mortality.
  • At long-term follow-up [median 24(7–84) months], the Kaplan-Meier analysis showed that patients with diabetes had a lower survival free from all-cause death (Log-rank P<.001>
  • In the propensity score-adjusted Cox multivariable analysis, DM (HR, 1.75; 95% CI, 1.18-2.60; P=.005), age (HR, 1.03; 95% CI, 1.02-1.05; P<.001 intravenous drug users ci p and low lvef were independent predictors of higher mortality.>

Limitations

  • Retrospective design.
  • Single-centre study.