Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 46, Doctor Esquerdo, 28007, Madrid, Spain.
Preventive Medicine and Public Health Teaching and Research Unit, School of Medicine, Complutense University, 58, Isaac Peral, 28040, Madrid, Spain.
Cardiovasc Diabetol. 2019 Nov 21;18(1):161. doi: 10.1186/s12933-019-0968-0.
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.
本研究的主要目的是描述在五个时间段（2001-2003 年、2004-2006 年、2007-2009 年、2010-2012 年和 2013-2015 年）中，≥40 岁患有或不患有 2 型糖尿病的感染性心内膜炎（IE）患者的住院率和结局，这些患者的数据来源于西班牙全国住院患者数据库。
我们根据糖尿病状况估算了住院率。我们分析了合并症、治疗方法和结局。我们构建了泊松回归模型，以比较住院率的调整时间趋势。使用倾向评分匹配（PSM）对 2 型糖尿病患者的病例与对照组进行匹配。我们在 logistic 回归分析中检验院内死亡率（IHM）。
我们在西班牙共识别了 16626 例年龄≥40 岁的 IE 住院患者，2001-2015 年期间。2 型糖尿病患者的 IE 发病率从 6.0/100,000 人年显著增加至 13.1/100,000 人年（p<0.001），无糖尿病患者的发病率从 3.9/100,000 人年增加至 5.5/100,000 人年（p<0.001）。研究期间，糖尿病患者的 IE 发病率调整后是无糖尿病患者的 2.2 倍（IRR=2.2；95%CI 2.1-2.3）。与无糖尿病患者相比，2 型糖尿病患者接受心脏瓣膜手术的比例较低（13.9%比 17.3%；p<0.001）。尽管两组的 IHM 随时间显著下降，但糖尿病患者的 IE 病例仍占 20.8%，PSM 匹配对照者的占 19.9%（p=0.337）。在因 IE 住院的患者中，2 型糖尿病与较高的 IHM 无关（OR=1.1；95%CI 0.9-1.2）。
在 2001-2015 年期间，西班牙 2 型糖尿病和非 2 型糖尿病患者的 IE 发病率均有所上升，其中 2 型糖尿病患者的发病率显著上升。在我们的基于人群的研究和 PSM 后，我们发现 2 型糖尿病不是 IE 患者 IHM 的预测因素。
