Infective Endocarditis in Diabetic Patients: A Different Profile with Prognostic Consequences

Abstract

Background. Infective Endocarditis (IE) is a severe condition. Diabetes mellitus (DM) has been associated with a poor prognosis in other settings. Our aim was to describe the profile and prognosis of IE with and without DM and to analyze the prognostic relevance of DM-related organ damage. Methods. Retrospective analysis of the Spanish IE Registry (2008–2020). Results. The cohort comprises 5590 IE patients with a mean age of 65.0 ± 15.5 years; 3764 (67.3%) were male. DM was found in 1625 patients (29.1%) and 515 presented DM-related organ damage. DM prevalence during the first half of the study period was 27.6% vs. 30.6% in the last half, p = 0.015. Patients with DM presented higher in-hospital mortality than those without DM (521 [32.1%] vs. 924 [23.3%], p < 0.001) and higher one-year mortality (640 [39.4%] vs. 1131 [28.5%], p < 0.001). Among DM patients, organ damage was associated with higher in-hospital (200 [38.8%] vs. 321 [28.9%], p < 0.001) and one-year mortality (247 [48.0%] vs. 393 [35.4%], p < 0.001). Multivariate analyses showed an independent association of DM with in-hospital (odds ratio [OR] = 1.34, 95% confidence interval [CI]: 1.16–1.55, p < 0.001) and one-year mortality (OR = 1.38, 95% CI: 1.21–1.59, p < 0.001). Among DM patients, organ damage was independently associated with higher in-hospital (OR = 1.37, 95% CI: 1.06–1.76, p = 0.015) and one-year mortality (OR = 1.59, 95% CI = 1.26–2.01, p < 0.001) Conclusions. The prevalence of DM among patients with IE is increasing and is already above 30%. DM is independently associated with a poor prognosis, particularly in the case of DM with organ damage.

Sex-related disparities in the incidence and outcomes of infective endocarditis according to type 2 diabetes mellitus status in Spain, 2016–2020

“…The prevalence of diabetes (26–29%) and the sex distribution (66–68% men) found in the GAMES registry are very similar to the corresponding values found in our study population (26.79% T2DM and 66.79% men) and this suggests the validity of our results [ 16 , 31 , 34 ]. In any case, in our opinion, there is no reason to think that coding validity differs among patients with and without T2DM.…”

“…However, our multivariable analysis did not show T2DM to be associated with higher IHM. Contrasting and similar results have been published [ 8 , 34 ]. Further larger, prospective, and more detailed studies are needed to clarify this issue.…”

“…In Spain the increase in the general population and among those with T2DM has been reported before, even if the increment seems to be slower than in other countries [ 3 , 8 , 30 , 31 , 33 ]. The trend suggests that, as reported elsewhere, the increase could be partly explained by aging, the burden of comorbidity, and a progressively higher number of invasive procedures [ 2 , 34 ]. In our study, the mean CCI and frequency of previous tricuspid and aortic valve disease increased significantly over time in patients with T2DM.…”

“…In Spain the results of hospital-based cohorts show much lower proportions of culture-negative endocarditis with figures ranging 10–20% [ 31 , 34 , 50 ]. In a recent study conducted among 3113 IE patients admitted to hospitals in Europe, from January 2016 to March 2019, a positive culture was obtained in 83.2%, whereas 16.8% had a culture-negative [ 51 ].…”

Multivalvular Endocarditis: A Rare Condition with Poor Prognosis

“…The Spanish Collaboration on Endocarditis, Grupo de Apoyo al Manejo de la endocarditis infecciosa en ESpaña (GAMES), is a national observational prospective registry that has been previously described [ 16 , 17 , 18 , 19 ]. Multidisciplinary teams, including infectious disease physicians, cardiologists, cardiac surgeons, microbiologists, echocardiographers, and other imaging specialists, have completed standardized case report forms with information regarding IE episodes and follow-up data.…”