Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jan 26, 2021; 13(1): 11-20
Published online Jan 26, 2021. doi: 10.4330/wjc.v13.i1.11
Clinical outcomes in patients with native valve infective endocarditis and diabetes mellitus
Temidayo Abe, Harry Onoriode Eyituoyo, Gabrielle De Allie, Titilope Olanipekun, Valery Sammah Effoe, Kikelomo Olaosebikan, Paul Mather
Temidayo Abe, Gabrielle De Allie, Titilope Olanipekun, Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA 30310, United States
Harry Onoriode Eyituoyo, Department of Internal Medicine, Mercer University School of Medicine, Macon, GA 31207, United States
Valery Sammah Effoe, Department of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA 30310, United States
Kikelomo Olaosebikan, Department of Medicine, University of Debrecen Medical and Health Science Center, Debrecen 4032, Hungary
Paul Mather, Department of Cardiovascular Disease, University of Pennsylvania, Pennsylvania, PA 19104, United States
Author contributions: Abe T and Eyituoyo HO contributed to study conception, interpretation of results, and manuscript write up; De Allie G, Olanipekun T and Olaosebikan K contributed to interpretation of results and manuscript write up; Effoe VS and Mather P contributed to study conception and critical review; all authors have read and approved the final manuscript.
Institutional review board statement: Data from this study used de-identified data from the National Inpatient Sample Database. A publicly available all-payer inpatient care database in the United States. Institutional Review Board Approval Form or Document is not required.
Informed consent statement: Data from this study used de-identified data from the National Inpatient Sample Database. A publicly available all-payer inpatient care database in the United States. Informed patient consent is not required.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Data sharing statement: Data that support the findings of this study are publicly available at https://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Temidayo Abe, MD, Staff Physician, Department of Internal Medicine, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, United States. tabe@msm.edu
Received: September 29, 2020
Peer-review started: September 29, 2020
First decision: December 7, 2020
Revised: December 18, 2020
Accepted: December 28, 2020
Article in press: December 28, 2020
Published online: January 26, 2021
Abstract
BACKGROUND

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

AIM

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

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Infective endocarditis, Native valve infective endocarditis, Diabetes mellitus, Valvular heart disease, Cardiovascular disease, National Inpatient Sample

Core Tip: In this observational study, we found increasing prevalence rates for diabetes mellitus (DM) among patients with native valve infective endocarditis (NVIE) from 2004–2014. There were significant differences in risk factors, microbiology, and in-patient procedures between patients with DM compared to those without DM. DM was associated with mortality, acute heart failure, stroke, atrioventricular block, septic shock, and cardiogenic shock. Independent predictors of in-hospital mortality in NVIE patients with DM include hemodialysis, congestive heart failure, atrial fibrillation, staphylococcus aureus, and older age.