Infective endocarditis and diabetes mellitus: Results from a single-center study from 1994 to 2017


Autoři: Rossella M. Benvenga aff001;  Roberta De Rosa aff001;  Angelo Silverio aff001;  Rosanna Matturro aff001;  Cristina Zambrano aff001;  Alfonso Masullo aff002;  Generoso Mastrogiovanni aff002;  Lucia Soriente aff002;  Roberto Ascoli aff002;  Rodolfo Citro aff002;  Federico Piscione aff001;  Gennaro Galasso aff001
Působiště autorů: Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy aff001;  Heart Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy aff002
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223710

Souhrn

Background

To evaluate the prognostic impact of diabetes mellitus (DM) in patients with Infective Endocarditis (IE).

Methods and results

375 patients with diagnosis of IE referred to our Hospital between 1994–2017 were retrospectively included; diabetes was reported in 129 (34.4%). Diabetic patients were older than non-diabetic (66±1 vs. 57±2 years, p<0.001) and showed a higher prevalence of comorbidities such as hypertension (75 vs. 54%, p<0.001), coronary artery disease (30 vs. 12%, p<0.001) and history of heart failure (HF; 24 vs. 13%, p = 0.021). Echocardiography showed a higher incidence of paravalvular complications (82 vs. 64%, p<0.001) and a lower left ventricular ejection fraction (LVEF; 52±11 vs. 55±10%, p = 0.001) in diabetic than in non-diabetic patients. In-hospital mortality was higher in diabetic patients (83 vs. 74%; p = 0.030). At logistic regression, history of HF (OR = 3.1, 95%CI: 1.87–5.29, p<0.001) resulted an independent predictor of in-hospital death.

At long-term follow-up [median 24(7–84) months], the Kaplan-Meier analysis showed a significantly lower survival free from all-cause death in the group with diabetes (Log-rank<0.001). At the propensity score adjusted Cox multivariable analysis, DM (HR = 1.76, 95%CI: 1.18–2.6, p = 0.005), age (HR = 1.03, 95%CI: 1.02–1.05, p<0.001), intravenous drug users (HR = 5.42, 95%CI: 2.55–11.51, p<0.001) and low LVEF (HR = 0.98, 95%CI: 0.96–0.99, p = 0.013) were independently associated to a higher mortality.

Conclusion

In patients with IE, DM is associated to a higher prevalence of anatomic complications and a more impaired LVEF. Diabetic patients show a significantly lower survival both in hospital and during follow-up compared to the non-diabetic ones.

Klíčová slova:

Cardiovascular diseases – Coronary heart disease – Echocardiography – Heart failure – Chronic kidney disease – Prosthetics – Surgical and invasive medical procedures


Zdroje

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Článek vyšel v časopise

PLOS One


2019 Číslo 11