Jensen Andreas Dalsgaard, Østergaard Lauge, Graversen Peter Laursen, Hadji-Turdeghal Katra, Petersen Jeppe K, Rossing Peter, Selmer Christian, Povlsen Jonas Agerlund, Voldstedlund Marianne, Bundgaard Henning, Moser Claus, Fosbøl Emil Loldrup
The Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 7, 16th floor, Copenhagen, 2100, Denmark.
The Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Infection. 2025 Sep 10. doi: 10.1007/s15010-025-02624-7.
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.
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.
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]).
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.
感染性心内膜炎（IE）合并糖尿病（DM）时会导致严重后果。我们旨在报告全国队列中按DM分层的IE患者的特征、微生物病因和死亡率。
我们使用丹麦登记处的数据，将首次发生IE（2010 - 2020年）的患者按DM分层。我们计算了入院后一年死亡率的逆Kaplan-Meier估计值。我们计算了入院和出院时调整后的一年死亡率的多变量调整Cox回归。
我们确定了6211例首次发生IE的患者；1503例（24.2%）患有DM（1型DM占26.1%，男性占68.1%，中位年龄72.7岁）；4708例（75.8%）未患DM（男性占67.0%，中位年龄72.4岁）。IE合并DM的患者慢性肾脏病的比例更高（35.9%对11.1%）。对于IE合并DM的患者，最主要的微生物是金黄色葡萄球菌（S. aureus）（36.5%），而未患DM的患者中最主要的是链球菌属（spp.）（29.4%）。IE合并DM的患者入院后一年死亡率增加（41.1% [95% CI：38.5% - 43.6%]对31.0% [95% CI：29.6% - 32.3%]）。与未患DM的患者相比，IE合并DM的患者入院一年时调整后的死亡率估计更高（HR = 1.15 [95% CI：1.04 - 1.27]），出院一年时也是如此（HR = 1.26 [95% CI：1.09 - 1.46]）。
IE合并DM的患者肾病负担更高，以金黄色葡萄球菌为主要微生物，入院和出院时一年死亡率均增加。这些发现呼吁改善DM患者IE的管理。
