Heart Centre, Rigshospitalet, Copenhagen, Denmark.
Zealand University Hospital, Roskilde, Department of Cardiology, Denmark.
Int J Cardiol. 2019 Mar 1;278:280-284. doi: 10.1016/j.ijcard.2018.09.106. Epub 2018 Oct 1.
Long duration of diabetes mellitus (DM) is associated with an increased risk of infection, however no studies have yet focused on the duration of DM and the associated risk of infective endocarditis (IE).
Patients with DM were identified through the Danish Prescription Registry, 1996-2015. Duration of DM was split in follow-up periods of: 0-5 years, 5-10 years, 10-15 years, and >15 years. Multivariable adjusted Poisson regression was used to calculate incidence rate ratios (IRR) according to study groups. DM late-stage complications and the associated risk of IE were investigated as time-varying covariates using the validated Diabetes Complications Severity Index (DCSI).
We included 299,551 patients with DM. In patients with DM duration of 0-5 years, 5-10 years, 10-15 years, and >15 years, the incidence rates of IE were 0.24, 0.33, 0.58, and 0.96 cases of IE/1000 person years, respectively. Patients with DM duration 5-10 years, 10-15 years, and >15 years were associated with a higher risk of IE with an IRR of 1.24 (95% CI: 1.02-1.51), 1.92 (95% CI: 1.52-2.43) and 3.05 (95% CI: 2.11-4.40), respectively, compared with DM duration 0-5 years. Patients with a DCSI score of 2, 3 and >3 were associated with a higher risk of IE compared with patients with a DCSI score of 0, IRR = 1.78 (95% CI: 1.34-2.36), IRR = 2.34 (95% CI: 1.73-3.16), and IRR = 2.59 (95% CI: 1.92-3.48), respectively.
This study shows a stepwise increase in the risk of IE with DM duration and severity independent of age and known comorbidity.
糖尿病（DM）的持续时间较长与感染风险增加相关，但尚无研究专门关注 DM 持续时间及其与感染性心内膜炎（IE）的关联。
通过丹麦处方登记处，于 1996 年至 2015 年期间确定了 DM 患者。DM 持续时间分为以下随访期：0-5 年、5-10 年、10-15 年和>15 年。采用多变量调整泊松回归计算按研究组计算发病率比（IRR）。使用经过验证的糖尿病并发症严重程度指数（DCSI）作为时变协变量，研究 DM 晚期并发症及其与 IE 的相关性。
我们纳入了 299551 例 DM 患者。在 DM 持续时间为 0-5 年、5-10 年、10-15 年和>15 年的患者中，IE 的发生率分别为 0.24、0.33、0.58 和 0.96 例/1000 人年。DM 持续时间为 5-10 年、10-15 年和>15 年的患者发生 IE 的风险更高，IRR 分别为 1.24（95%CI：1.02-1.51）、1.92（95%CI：1.52-2.43）和 3.05（95%CI：2.11-4.40），与 DM 持续时间 0-5 年相比。与 DCSI 评分为 0 的患者相比，DCSI 评分为 2、3 和>3 的患者发生 IE 的风险更高，IRR 分别为 1.78（95%CI：1.34-2.36）、IRR 分别为 2.34（95%CI：1.73-3.16）和 IRR 分别为 2.59（95%CI：1.92-3.48）。
本研究表明，随着 DM 持续时间和严重程度的增加，IE 的风险呈逐步增加，与年龄和已知合并症无关。
