Infective endocarditis and relationship with diabetes mellitus - Patient characteristics, microbial etiology and mortality

PURPOSE: Infective endocarditis (IE) has been associated with severe outcomes when complicated by diabetes mellitus (DM). We aimed to report characteristics, microbial etiology, and mortality for patients with IE stratified by DM from a nationwide cohort.

METHODS: We used Danish registries, and patients with first-time IE (2010-2020) were stratified by DM. We computed inverse Kaplan-Meier estimates for one-year mortality from admission. We computed multivariable adjusted Cox regression for the adjusted one-year mortality from admission and discharge.

RESULTS: We identified 6,211 patients with first-time IE; 1,503 (24.2%) with DM (26.1% Type 1 DM, 68.1% male, median age 72.7 years); 4,708 (75.8%) did not have DM (67.0% male, median age 72.4 years). Patients with IE and DM had a higher proportion of chronic kidney disease (35.9% vs. 11.1%). The most predominant microorganism was Staphylococcus aureus (S. aureus) for patient with IE and DM (36.5%), and Streptococcus species (spp.) for those without DM (29.4%). Patients with IE and DM were associated with an increased one-year mortality from admission (41.1% [95% CI: 38.5%-43.6%] vs. 31.0% [95% CI: 29.6%-32.3%]). The adjusted mortality estimates were higher for patients with IE and DM compared to those without DM one year from admission (HR = 1.15 [95% CI: 1.04-1.27]), and one year from discharge (HR = 1.26 [95% CI: 1.09-1.46]).

CONCLUSION: Patients with IE and DM were associated with a higher burden of kidney disease, S. aureus as the predominant microorganism, and increased one-year mortality both from admission and discharge. These findings call for improved management of IE in patients with DM.