Diabetes mellitus and insulin therapy in infective endocarditis

Abstract

Infective endocarditis (IE) is an uncommon disease but is associated with substantial morbidity and mortality. In the contemporary era, despite advancements in diagnosis and both antimicrobial and surgical therapies, IE is associated with an in-hospital mortality rate of nearly 20%.1,2 Given this high mortality, numerous studies have investigated clinical characteristics of IE that are associated with poor outcome. On the basis of such observational studies, current consensus guidelines for the evaluation and treatment of IE3,4 outline complications of IE that are indications for cardiac surgery in active IE. In addition to describing prognostic complications of IE, observational studies have identified demographic, echocardiographic, and microbiologic characteristics associated with poorer outcome.1,2,5 The role of diabetes mellitus (DM) in the outcome of IE has been previously investigated. In a study of 267 patients with possible or definite IE including 88 (33%) with DM, Chu et al .1 found that DM was a strong, independent early predictor of in-hospital mortality. Recently, an analysis of the large, multicentre International Collaboration on Endocarditis (ICE) Merged Database found that DM patients with IE had an in-hospital mortality rate of 30.3% compared with 18.6% for non-DM patients, and confirmed that DM was independently associated with in-hospital mortality.2 However, no statistically significant differences in … Corresponding author. Tel: +1 919 643 1674; fax: +1 919 681 7917. E-mail address : a.wang{at}duke.edu