Clinical Features, Etiology, and Outcomes of Community-Acquired Pneumonia in Patients With Diabetes Mellitus

Abstract

We performed an observational analysis of a prospective cohort of immunocompetent hospitalized adults with community-acquired pneumonia (CAP) to determine the epidemiology, clinical features, and outcomes of pneumonia in patients with diabetes mellitus (DM). We also analyzed the risk factors for mortality and the impact of statins and other cardiovascular drugs on outcomes. Of 2407 CAP episodes, 516 (21.4%) occurred in patients with DM; 483 (97%) had type 2 diabetes, 197 (40%) were on insulin treatment, and 119 (23.9%) had end-organ damage related to DM. Patients with DM had different clinical features compared to the other patients. They were less likely to have acute onset, cough, purulent sputum, and pleural chest pain. No differences in etiology were found between study groups. Patients with DM had more inhospital acute metabolic complications, although the case-fatality rate was similar between the groups. Independent risk factors for mortality in patients with DM were advanced age, bacteremia, septic shock, and gram-negative pneumonia. Patients with end-organ damage related to DM had more inhospital cardiac events and a higher early case-fatality rate than did the overall population. The use of statins and other cardiovascular drugs was not associated with better CAP outcomes in patients with DM. In conclusion, CAP in patients with DM presents different clinical features compared to the features of patients without DM.

Evidence of non‐linearity in the association of glycemic control with influenza/pneumonia mortality: a study of 19 000 adults from the US general population

“…Detailed work in humans suggests that higher mortality after community‐acquired pneumonia more likely is due to an increased burden of cardiovascular or renal comorbidity in diabetes , but immune function could be analysed only on the level of circulating and cell‐surface markers in that study. The comorbidity explanation would be in line with another study on patients with community‐acquired pneumonia finding higher rates of in‐hospital complications and mortality only in subjects with diabetic end‐organ damage , and data from the second NHANES also seem to suggest cardiovascular conditions to play a role in increased infectious disease mortality in diabetes . In the present study, the similar magnitude of effect estimates for the primary outcome compared with general mortality analysis also would be consistent with such a rather unspecific link between diabetes and infectious disease mortality, which ultimately could be altogether due to shared risk factors between these two entities.…”

Pneumonia in patients with diabetes mellitus: A single center experience

“…[2] Data regarding the effect of diabetes on the duration of pneumonia are conflicting. [5][6][7] Patients among the diabetic group with pneumonia in our study had a significantly longer hospitalization time and greater rate of referral to the ICU compared with patients without pneumonia (p<0.05). However, there was no difference with respect to mortality rate (p>0.05).…”

“…On the other hand, in numerous studies examining etiology, clinical features, outcomes of CAP in diabetic patients, age, presence of gram-negative pneumonia, septic shock table result upon admission, and bacteremia mortality have been found to be associated in multivariate analysis. [7] Chronic pulmonary disease, chronic heart disease, hypertension, male gender, CRP and urea level were found to be factors affecting mortality in multivariate analysis in our study. However, the presence of diabetes was not found to be associated with mortality.…”

Application of the Formula for Rational Antimicrobial Therapy (FRAT) to Community-Acquired Pneumonia

“…Patients with diabetes have been found to have different clinical features of CAP compared to other patients [79], are at risk for CAP not just during winter months, but throughout the year [65], and patients with both diabetes and CAP also have a higher frequency of other conditions such as COPD [76], adding complexity to diagnosis and effective antimicrobial therapy.…”