Macro and microvascular complications are determinants of increased infection-related mortality in Brazilian type 2 diabetes mellitus patients

Objective: To investigate infection-related mortality and its predictors in Brazilian type 2 diabetic patients. Methods: It was carried out a long-term prospective study with 471 type 2 diabetic outpatients. Several clinical, laboratory and electrocardiographic variables were recorded at baseline. Predictive factors for infection-related mortality were evaluated by Kaplan-Meyer estimation of survival curves, univariate and multivariate Cox survival analysis. Excess infection-related mortality in this cohort was evaluated by comparing its rate with that of the Rio de Janeiro background population and calculating standardized mortality rates (SMR). Results: During a median follow up of 57 months (range: 1-86 months), 40 (33.1%) patients died from infection-related causes. After adjusting for age and sex, the infection-related SMR was 6.6 (95% confidence interval [95% CI]: 4.8-9.0). In Cox multivariate analysis the predictors of infection-related mortality were older age (hazard ratio [HR]: 1.91; 95% CI: 1.35-2.70), pre-existing peripheral arterial disease (HR: 3.86; 95% CI: 1.80-8.28) and cerebrovascular disease (HR: 3.28; 95% CI: 1.24-8.70), lower HDL-cholesterol (HR: 2.50; 95% CI: 1.32-4.74) and increased 24 h-proteinuria (HR: 1.22; 95% Cl: 1.08-1.37). After excluding patients with peripheral and cerebrovascular disease at baseline, neuropathy and coronary heart disease were selected as predictors of mortality, besides older age and proteinuria. Conclusions: Brazilian type 2 diabetic patients have a six-fold excess infection-related mortality than the general population. This increased mortality is mainly determined by the presence of micro and macrovascular complications. Multifactorial risk interventions are needed in order to decrease this burden of infection-related mortality. (c) 2006 Elsevier Ireland Ltd. All rights reserved.