Abstract
BackgroundThe present study was performed to investigate the impacts of type 2 diabetes mellitus (T2DM) on severe community-acquired pneumonia (SCAP) and to develop a novel prediction model for mortality in SCAP patients with T2DM.MethodsThis was a retrospective observational study conducted in consecutive adult patients with SCAP admitted to the intensive care unit (ICU) of West China Hospital, Sichuan University, China, between September 2011 and September 2019. The primary outcome was hospital mortality. A propensity score matching (PSM) analysis model with a 1:2 ratio was used for the comparisons of clinical characteristics and outcomes between T2DM and nondiabetic patients. The independent risk factors were identified via univariate and then multivariable logistic regression analysis and were then used to establish a nomogram.ResultsIn total, 1262 SCAP patients with T2DM and 2524 matched patients without T2DM were included after PSM. Patients with T2DM had longer ICU length of stay (LOS) (13 vs. 12 days, P = 0.016) and higher 14-day mortality (15% vs. 10.8%, P < 0.001), 30-day mortality (25.7% vs. 22.7%, P = 0.046), ICU mortality (30.8% vs. 26.5%, P = 0.005), and hospital mortality (35.2% vs. 31.0%, P = 0.009) than those without T2DM. In SCAP patients with T2DM, the independent risk factors for hospital mortality were increased numbers of comorbidities and diabetes-related complications; elevated C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), brain natriuretic peptide (BNP) and blood lactate; as well as decreased blood pressure on admission. The nomogram had a C index of 0.907 (95% CI: 0.888, 0.927) in the training set and 0.873 (95% CI: 0.836, 0.911) in the testing set, which was superior to the pneumonia severity index (PSI, AUC: 0.809, 95% CI: 0.785, 0.833). The calibration curve and decision curve analysis (DCA) also demonstrated its accuracy and applicability.ConclusionsSCAP patients with T2DM had worse clinical outcomes than nondiabetic patients. The nomogram has good predictive performance for hospital mortality and might be generally applied after more external validations.
Highlights
The present study was performed to investigate the impacts of type 2 diabetes mellitus (T2DM) on severe community-acquired pneumonia (SCAP) and to develop a novel prediction model for mortality in SCAP patients with T2DM
propensity score matching (PSM) and clinical characteristics among SCAP patients In total, 6992 patients were identified with SCAP in the present study
Kornum et al demonstrated that diabetic patients had greater adjusted 30-day (RR: 1.16, 95% 95% Confidence interval (CI): 1.07–1.27) and 90-day mortality
Summary
The present study was performed to investigate the impacts of type 2 diabetes mellitus (T2DM) on severe community-acquired pneumonia (SCAP) and to develop a novel prediction model for mortality in SCAP patients with T2DM. According to the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) consensus guidelines, severe community-acquired pneumonia (SCAP) was defined as fulfilment of at least 1 major criterion (septic shock with need for vasopressors; respiratory failure requiring mechanical ventilation) or 3 minor criteria (respiratory rate ≥ 30 breaths/min; PaO2/FiO2 ratio ≤ 250; multilobar infiltrates; confusion/disorientation; blood urea nitrogen level ≥ 20 mg/dL; white blood cell count < 4000 cells/μL; platelet count < 100,000/μL; core temperature < 36 °C; hypotension requiring aggressive fluid resuscitation) [3]. Cavallazzi et al conducted a prospective population-based cohort study including 7449 patients in the USA. They reported that 23% of CAP patients required intensive care, and their mortality rates were 27% at 30 days and 47% at one year [5]
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