IJCS | Volume 33, Nº1, January / February 2019

18 Table 3 - Cardiac structures affected in 211 patients with Infective Endocarditis Location IUD (n = 9) NIUD (n = 8) ND (n = 194)* Total (n = 211)* p-value Native valves 7 (77.8%) 3 (37.5%) 139 (71.6%) 149 (70.6%) 0.642† Mitral 3 (33.3%) 2 (25%) 83 (42.8%) 88 (41.7%) 0.369† Aortic 1 (11.1%) 1 (12.5%) 54 (27.8%) 56 (26.5%) 0.168† Tricuspid 3 (33.3%)‡ - 18 (9.3%)‡ 21 (10%) 0.034† Pulmonary - - 3 (1.5%) 3 (1.4%) - Prosthetic valves 1 (11.1%) 3 (37.5%) 47 (24.2%) 51 (24.2%) 0.640† Pacemaker cable - - 9 (4.6%) 9 (4.3%) - Others § 1 (11.1%) - 5 (2.6%) 6 (2.8%) 0.237† Unidentified location - 2 (25%)‡ 1 (0.5%)‡ 3 (0.1%) 0.031† IUD: insulin-user diabetics; NIUD: non-insulin-user diabetics; ND: non diabetics; *Some patients showed lesions in more than one place; †Association evaluated via multinomial logistic model; †Indicates pairs with significant difference (p < 0.05); § Right Atrium, Pulmonary Arteries, Ostium of the interventricular defect, Ostium of Superior Vena Cava. Table 4 - Characteristics of diabetic individuals with Infective Endocarditis according to insulin use Aspect IUD (n = 9) NIUD (n = 8) p-value Health care related IE† 2 (22.2%) 3 (37.5%) 0.620 Systemic arterial hypertension 9 (100%) 7 (87.5%) 0.471 Dyslipidemia 5 (55.5%) 4 (50%) 1.000 CHF NYHA III* 3 (33.3%) 2 (25%) 1.000 Valvulopathy 2 (22.2%) 3 (37.5%) 0.620 Coronary artery disease 2 (22.2%) 3 (37.5%) 0.620 Dialytic chronic kidney disease 2 (22.2%) 2 (25%) 1.000 Non-dialytic chronic kidney disease 1 (11.1%) 1 (12.5%) 1.000 Smoking 3 (33.3%) 4 (50%) 0.637 Alcohol consumption 3 (33.3%) 2 (25%) 1.000 † According to the definition used by Yang et al.28. We included in this group 4 patients undergoing kidney dialysis and 1 patient in long-term care. It was not possible to evaluate hospitalizations up to 90 days prior to IE manifestations, so this criterion was not used. NIUD: non- insulin-user diabetics; IUD: insulin-user diabetics. The p-values refer to Fisher's exact test. * NYHA Class III Congestive Heart Failure. Lott Bezerra et al. Insulin use and infective endocarditis Int J Cardiovasc Sci. 2020;33(1):14-21 Original Article was not possible to reliably collect these same variables for non-diabetic patients in our sample, which could represent a limitation in the comparison with this group. Discussion When considering the general data of all 211 patients with IE in our population, regardless of whether or not they were diabetics, findings consistent with large observational studies in the literature can be observed. The multicenter study by Murdoch et al., 1 with 2781 patients with IE, showed a mortality rate of 18.0%, comparable to the 22.3% in our results. Moreover, the proportion of diabetic patients with IE was 8.0% (n = 17), similar to the 10.0% found by the same study byMurdoch et al., 1 when only South America was considered. The microbiological profile evaluated in the literature shows differences according to the affected site. The findings were proportional to those in the study by Murdoch et al., 1 when considering only South America (n = 254), which showed a predominance of Streptococcus sp. in 26.0%, followed by S. aureus in 17%, whereas ours results showed 25.0%and 18.0%, respectively. In contrast, Nunes et al. 29 (n = 62) and Ruiz et al. 30 (n = 159), in Belo Horizonte, state of Minas Gerais and Ribeirão Preto, state of São Paulo, respectively, found a higher prevalence of S. aureus ( 32.0% and 27.0%).