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



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.


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


1. Habib G. Management of infective endocarditis. Heart. 2006; 92(1):124–30. doi: 10.1136/hrt.2005.063719 16365367.

2. Lockart PB, Loven B, Brennan MT, Fox PC. The evidence base for the efficacy of antibiotic prophylaxis in dental practice. J Am Dent Assoc. 2007; 138: 458–74. doi: 10.14219/jada.archive.2007.0198 17403736.

3. Hoen B, Duval X. Infective endocarditis. NEJM. 2013; 368: 1425–33. doi: 10.1056/NEJMcp1206782 23574121.

4. Chirillo F, Pedrocco A, De Leo A, Bruni A, Totis O, Meneghetti P et al. Impact of harmonic imaging on transthoracic echocardiographic identification of infective endocarditis and its complications. Heart. 2005; 91:329–33. doi: 10.1136/hrt.2003.031583 15710712.

5. Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, et al. Guidelines on the prevention, diagnosis and treatment of infective endocarditis (new version 2009). European Heart Journal.2009; 30: 2369–2413. doi: 10.1093/eurheartj/ehp285 19713420

6. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F et al. ESC Scientific Document Group. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J. 2015; 36:3075–3128. doi: 10.1093/eurheartj/ehv319 26320109.

7. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, Rybak MJ et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation. 2015;132(15):1435–86. doi: 10.1161/CIR.0000000000000296 Epub 2015 Sep 15. 26373316.

8. Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009; 169: 463–473. doi: 10.1001/archinternmed.2008.603 19273776.

9. Moreillon P, Que YA. Infective endocarditis. Lancet. 2004; 363:139–49. doi: 10.1016/S0140-6736(03)15266-X 14726169.

10. Thuny F, Grisoli D, Collart F, Habib G, Raoult D. Management of infective endocarditis: challenges and perspectives. Lancet. 2012; 379:965–75. doi: 10.1016/S0140-6736(11)60755-1 22317840.

11. Cahill TJ, Baddour LM, Habib G, Hoen B, Salaun E, Pettersson GB et al. Challenges in Infective Endocarditis. JACC. 2017;69:325–344. doi: 10.1016/j.jacc.2016.10.066 28104075.

12. Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B. Impaired leucocyte functions in diabetic patients. Diabet Med. 1997;14:29–34. doi: 10.1002/(SICI)1096-9136(199701)14:1<29::AID-DIA300>3.0.CO;2-V 9017350.

13. von Reyn FC, Arbeit RD, Friedland GH, Crumpacker CS. Criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 1994;19:368–70. doi: 10.1093/clinids/19.2.368 7864961.

14. Durack DT, Lukes AS, Bright DK, Duke Endocarditis Service. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Am J Med. 1994; 96:200–9. doi: 10.1016/0002-9343(94)90143-0 8154507.

15. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000; 30:633–638. doi: 10.1086/313753 10770721.

16. Chamberlain JJ, Rhinehart AS, Shaefer CF Jr, Neuman A. Diagnosis and Management of Diabetes: Synopsis of the 2016 American Diabetes Association Standards of Medical Care in Diabetes. Ann Intern Med. 2016;164:542–552. doi: 10.7326/M15-3016 26928912.

17. Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M et al. Recommendations for the practice of echocardiography in infective endocarditis. European Journal of Echocardiography. 2010; 11:202–19. doi: 10.1093/ejechocard/jeq004 20223755.

18. Sanfilippo AJ, Picard MH, Newell JB, Rosas E, Davidoff R, Thomas JD et al. Echocardiographic assessment of patients with infectious endocarditis: prediction of risk for complications. Journal of the American College of Cardiology. 1991; 18:1191–9. doi: 10.1016/0735-1097(91)90535-h 1918695.

19. Hasbun R, Holenarasipur R, Barakat LA, Buenconsejo J, Quagliarello VJ. Complicated Left-Sided Native Valve Endocarditis in Adults Risk Classification for Mortality. JAMA. 2003;289:1933–1940. doi: 10.1001/jama.289.15.1933 12697795.

20. Netzer RO, Altwegg SC, Zollinger E, Tauber M, Carrel T, Seiler C. Infective endocarditis: determinants of long term outcome. Heart. 2002; 88:61–6. doi: 10.1136/heart.88.1.61 12067947.

21. Movahed MR, Hashemzadeh M, Jamal MM. Increased prevalence of infectious endocarditis in patients with type II diabetes mellitus. J Diabetes Complications. 2007; 21:403–6. doi: 10.1016/j.jdiacomp.2007.07.003 17967715.

22. Lin CJ, Chua S, Chung SY, Hang CL et Tsai TH. Diabetes Mellitus: An Independent Risk Factor of In-Hospital Mortality in Patients with Infective Endocarditis in a New Era of Clinical Practice. Int J Environ Res Public Health. 2019 Jun 25;16(12). pii: E2248. doi: 10.3390/ijerph16122248 31242695.

23. Wallace SM, Walton BI, Kharbanda RK, Hardy R, Wilson AP, Swanton RH. Mortality from infective endocarditis: clinical predictors of outcome. Heart. 2002; 88:53–60. doi: 10.1136/heart.88.1.53 12067945.

24. Moreno R, Zamorano J, Almería C, Villate A, Rodrigo JL, Herrera D et al. Influence of diabetes mellitus on short- and long-term outcome in patients with active infective endocarditis. J Heart Valve Dis. 2002; 11:651–9. 12358401.

25. Chu VH, Cabell CH, Benjamin DK Jr, Kuniholm EF, Fowler VG Jr, Engemann J et al. Early predictors of in-hospital death in infective endocarditis. Circulation. 2004;109:1745–9. doi: 10.1161/01.CIR.0000124719.61827.7F 15037538.

26. Chirillo F, Bacchion F, Pedrocco A, Scotton P, De Leo A, Rocco F et al. Infective endocarditis in patients with diabetes mellitus. J Heart Valve Dis. 2010;19:312–20.20583393.

27. Kourany WM, Miro JM, Moreno A, Corey GR, Pappas PA, Abrutyn E et al. Influence of diabetes mellitus on the clinical manifestations and prognosis of infective endocarditis: a report from the International Collaboration on Endocarditis-Merged Database. Scand J Infect Dis. 2006; 38:613–9. doi: 10.1080/00365540600617017 16857604.

28. Duval X, Alla F, Doco-Lecompte T, Le Moing V, Delahaye F, Mainardi JL et al. Diabetes mellitus and infective endocarditis: the insulin factor in patient morbidity and mortality. Eur Heart J. 2007;28:59–64. doi: 10.1093/eurheartj/ehl318 17040927.

29. Thuny F, Giorgi R, Habachi R, et al. Excess mortality and morbidity in patients surviving infective endocarditis. Am Heart J. 2012; 164:94–101. doi: 10.1016/j.ahj.2012.04.003 22795288.

30. Hasbun R, Holenarasipur R, Barakat LA, Buenconsejo J, Quagliarello VJ. Complicated Left-Sided Native Valve Endocarditis in Adults Risk Classification for Mortality. JAMA. 2003;289:1933–1940. doi: 10.1001/jama.289.15.1933 12697795.

31. Fowler VG Jr, Miro JM, Hoen B, et al. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA. 2005;293:3012–3021. doi: 10.1001/jama.293.24.3012 15972563.

32. Cecchi E, Chirillo F, Castiglione A, Faggiano P, Cecconi M, Moreo A et al. Clinical epidemiology in Italian Registry of Infective Endocarditis (RIEI): Focus on age, intravascular devices and enterococci. Int J Cardiol. 2015; 190:151–156. doi: 10.1016/j.ijcard.2015.04.123 25918069.

33. Thuny F, Giorgi R, Habachi R, Ansaldi S, Le Dolley Y, Casalta JP et al. Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation. 2005;112:69–75. doi: 10.1161/CIRCULATIONAHA.104.493155 15983252.

34. Chu VH, Woods CW, Miro JM, Hoen B, Cabell CH, Pappas PA et al. Emergence of coagulase-negative staphylococci as a cause of native valve endocarditis. Clin Infect Dis. 2008;46:232–242. doi: 10.1086/524666 18171255.

Článek vyšel v časopise


2019 Číslo 11