• ACHD
• Cardiac surgery
• Infective endocarditis
• National registers
• Valve replacement

• Humans
• Male
• Female
• Heart Defects, Congenital/epidemiology
• Heart Defects, Congenital/diagnosis
• Heart Defects, Congenital/surgery
• Registries
• Sweden/epidemiology
• Adult
• Endocarditis/epidemiology
• Endocarditis/diagnosis
• Risk Factors
• Middle Aged
• Follow-Up Studies
• Young Adult
• Predictive Value of Tests
• Adolescent

• acute heart failure
• early surgery
• in-hospital mortality
• infective endocarditis
• septic shock

• CHA2DS2-VASc
• endocarditis
• endocarditis team
• risk prognostication

• T1DM
• cardiac disease
• cerebrovascular disease
• disease burden
• hospitalization cost
• inpatient
• mortality
• type 1 diabetes mellitus

• diabetes mellitus
• in-hospital mortality
• infective endocarditis
• one-year mortality
• organ damage
• prognosis

• endocarditis
• surgical outcome

There is a lack of data on the clinical outcomes in patients with native valve infective endocarditis (NVIE) and diabetes mellitus (DM).

To investigate (1) trends in the prevalence of DM among patients with NVIE; and (2) the impact of DM on NVIE outcomes.

We identified 76385 with NVIE from the 2004 to 2014 National Inpatient Sample, of which 22284 (28%) had DM. We assessed trends in DM from 2004 to 2014 using the Cochrane Armitage test. We compared baseline comorbidities, microorganisms, and in-patients procedures between those with vs without DM. Propensity match analysis and multivariate logistic regression were used to investigate study outcomes in in-hospital mortality, stroke, acute heart failure, cardiogenic shock, septic shock, and atrioventricular block.

Crude rates of DM increased from in 22% in 2004 to 30% in 2014. There were significant differences in demographics, comorbidities and NVIE risk factors between the two groups. Staphylococcus aureus was the most common organism identified with higher rates in patients with DM (33.1% vs 35.6%; P < 0.0001). After propensity matching, in-hospital mortality (11.1% vs 11.9%; P < 0.0001), stroke (2.3% vs 3.0%; P < 0.0001), acute heart failure (4.6% vs 6.5%; P = 0.001), cardiogenic shock (1.5% vs 1.9%; P < 0.0001), septic shock (7.2% vs 9.6%; P < 0.0001), and atrioventricular block (1.5% vs 2.4%; P < 0.0001), were significantly higher in patients with DM. Independent predictors of mortality in NVIE patients with DM include hemodialysis, congestive heart failure, atrial fibrillation, staphylococcus aureus, and older age.

There is an increasing prevalence of DM in NVIE and it is associated with poorer outcomes. Further studies are crucial to identify the clinical, and sociodemographic contributors to this trend and develop strategies to mitigate its attendant risk.

• Infective endocarditis
• Native valve infective endocarditis
• Diabetes mellitus
• Valvular heart disease
• Cardiovascular disease
• National Inpatient Sample

• Staphylococcus warneri
• bicuspid aortic valve
• coagulase-negative staphylococcus (CoNS)
• diabetes mellitus
• infective endocarditis (IE)
• native valve endocarditis (NVE)

• Aortic Valve/surgery
• Diabetes Mellitus, Type 1/complications
• Echocardiography
• Endocarditis, Bacterial/complications
• Endocarditis, Bacterial/microbiology
• Endocarditis, Bacterial/surgery
• Heart Failure/complications
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Staphylococcal Infections/complications
• Staphylococcal Infections/microbiology
• Staphylococcal Infections/surgery
• Staphylococcus

• Biomarkers
• Infective endocarditis
• Mortality
• Prognosis

The main aims of this study were to describe trends and outcomes during admission for infective endocarditis (IE) in people ≥ 40 years old with or without type 2 diabetes distributed in five time-periods (2001–2003; 2004–2006; 2007–2009; 2010–2012 and 2013–2015), using Spanish national hospital discharge data.

We estimated admission rates by diabetes status. We analyzed comorbidity, therapeutic procedures, and outcomes. We built Poisson regression models to compare the adjusted time-trends in admission rates. Type 2 diabetes cases were matched with controls using propensity score matching (PSM). We tested in-hospital mortality (IHM) in logistic regression analyses.

We identified 16,626 hospitalizations in patients aged ≥ 40 years for IE in Spain, 2001–2015. The incidence of IE increased significantly from 6.0/100,000 per year to 13.1/100,000 per year (p < 0.001) in the population with type 2 diabetes, and from 3.9/100,000 per year to 5.5/100,000 per year (p < 0.001) in the population without diabetes, over the study period. The adjusted incidence of IE was 2.2-times higher among patients with diabetes than among those without diabetes (IRR = 2.2; 95% CI 2.1–2.3). People with type 2 diabetes less often underwent heart valve surgery than people without diabetes (13.9% vs. 17.3%; p < 0.001). Although IHM decreased significantly in both groups over time, it represented 20.8% of IE cases among diabetes patients and 19.9% among PSM matched controls (p = 0.337). Type 2 diabetes was not associated with a higher IHM in people admitted to the hospital for IE (OR = 1.1; 95% CI 0.9–1.2).

Incidence rates of IE in Spain, among those with and without T2DM, have increased during the period 2001–2015 with significantly higher incidence rates in the T2DM population. In our population based study and after PSM we found that T2DM was not a predictor of IHM in IE.

• Comorbidities
• Heart valve surgery
• In-hospital mortality
• Infective endocarditis
• Type 2 diabetes mellitus

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

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.

Infective endocarditis (IE) is a severe disease with a hospital mortality rate of 17–25%. Early identification of IE patients with high risk of mortality may improve their clinical outcomes. Patients with diabetes mellitus (DM) who develop infective diseases are associated with worse outcomes. This study aimed to define the impact of DM on long-term mortality in IE patients. A total of 412 patients with definite IE from February 1999 to June 2012 were enrolled in this observational study and divided into 2 groups: group 1, patients with DM (n = 72) and group 2, patients without DM (n = 340). The overall in-hospital mortality rate for both groups combined was 20.2% and was higher in group 1 than in group 2 (41.7% vs. 16.5%, p < 0.01). Compared to patients without DM, patients with DM were older and associated with higher incidence of chronic diseases, less drug abuse, higher creatinine levels, and increased risk of Staphylococcus aureus infection (all p < 0.05). Moreover, they were more likely to have atypical clinical presentation and were associated with longer IE diagnosis time (all p < 0.05). In multivariable analysis, DM is an independent and significant predictor of mortality. The prognosis of IE patients with DM is still poor. Early identification and more aggressive treatment may be considered in IE patients with DM.

• diabetes mellitus
• infective endocarditis
• mortality

• Adult
• Aged
• Diabetes Mellitus/mortality
• Endocarditis/mortality
• Female
• Hospital Mortality
• Humans
• Incidence
• Male
• Middle Aged
• Prognosis
• Risk Factors
• Staphylococcal Infections/epidemiology

• Adult
• Aged
• Comorbidity
• Diabetes Mellitus/diagnosis
• Diabetes Mellitus/mortality
• Diabetic Angiopathies/diagnosis
• Diabetic Angiopathies/mortality
• Endocarditis/complications
• Endocarditis/diagnosis
• Endocarditis/mortality
• Female
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Prediabetic State/complications
• Prediabetic State/diagnosis
• Prediabetic State/mortality
• Prognosis
• Risk Factors

• 2015A020210064 Science and Technology Projects of Guangdong
• 2014Y2-00191 Science and Technology Planning Project of Guangzhou City
• 201707010002 Science and Technology Planning Project of Guangzhou City

• Diabetes late-stage complications
• Diabetes mellitus
• Infective endocarditis

• Cardiac device
• Cardiac imaging
• Cardiac surgery
• Congenital heart disease
• Echocardiography
• Endocarditis
• Guidelines
• Infection
• Nuclear imaging
• Pregnancy
• Prevention
• Prognosis
• Prophylaxis
• Prosthetic heart valves
• Valve disease

• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/therapy
• Ambulatory Care
• Aneurysm, Infected/diagnosis
• Aneurysm, Infected/therapy
• Anti-Bacterial Agents/therapeutic use
• Antibiotic Prophylaxis
• Arrhythmias, Cardiac/diagnosis
• Arrhythmias, Cardiac/therapy
• Clinical Laboratory Techniques
• Critical Care
• Cross Infection/etiology
• Dentistry, Operative
• Diagnostic Imaging/methods
• Embolism/diagnosis
• Embolism/therapy
• Endocarditis/diagnosis
• Endocarditis/therapy
• Endocarditis, Non-Infective/diagnosis
• Endocarditis, Non-Infective/therapy
• Female
• Fibrinolytic Agents/therapeutic use
• Heart Defects, Congenital
• Heart Failure/diagnosis
• Heart Failure/therapy
• Heart Valve Diseases/diagnosis
• Heart Valve Diseases/therapy
• Humans
• Long-Term Care
• Microbiological Techniques
• Musculoskeletal Diseases/diagnosis
• Musculoskeletal Diseases/microbiology
• Musculoskeletal Diseases/therapy
• Myocarditis/diagnosis
• Myocarditis/therapy
• Neoplasms/complications
• Nervous System Diseases/diagnosis
• Nervous System Diseases/microbiology
• Nervous System Diseases/therapy
• Patient Care Team
• Pericarditis/diagnosis
• Pericarditis/therapy
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control
• Pregnancy
• Pregnancy Complications, Cardiovascular/diagnosis
• Pregnancy Complications, Cardiovascular/therapy
• Prognosis
• Prosthesis-Related Infections/diagnosis
• Prosthesis-Related Infections/therapy
• Recurrence
• Risk Assessment
• Risk Factors
• Splenic Diseases/diagnosis
• Splenic Diseases/therapy
• Thoracic Surgical Procedures

• Age Factors
• Aged
• Diabetes Complications
• Diabetes Mellitus/epidemiology
• Endocarditis/complications
• Endocarditis/epidemiology
• Endocarditis/microbiology
• Female
• Humans
• Male
• Middle Aged
• Prognosis
• Sex Factors
• Shock, Septic/epidemiology
• Tertiary Care Centers

• Charlson Co-morbidity Index
• Infective endocarditis
• Mortality

• Aged
• Anti-Bacterial Agents/therapeutic use
• Diabetes Mellitus, Type 1/complications
• Diabetes Mellitus, Type 1/microbiology
• Diabetic Angiopathies/microbiology
• Diabetic Neuropathies/microbiology
• Drug Therapy, Combination
• Endocarditis, Bacterial/complications
• Enterococcus
• Female
• Fever/etiology
• Humans
• Myocardial Infarction
• Streptococcal Infections/complications
• Streptococcal Infections/diagnosis

• Antibiotic Prophylaxis
• Endocarditis/prevention & control
• Humans
• Risk Assessment