Yıl: 2023 Cilt: 53 Sayı: 6 Sayfa Aralığı: 1776 - 1785 Metin Dili: İngilizce DOI: 10.55730/1300-0144.5747 İndeks Tarihi: 18-01-2024

Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients

Öz:
Background/aim: Community-acquired pneumonia (CAP) is one of the leading infectious causes of mortality, and diabetes mellitus is a globally prevalent disease. Consequently, the cooccurrence of these two disorders can be common and create challenging medical conditions. Therefore, it was aimed to compare the various aspects of CAP in diabetic and nondiabetic patients, in order to have a comprehensive and comparative picture of the differences. Materials and methods: In this cross-sectional study, CAP patients with and without diabetes were assessed for clinicoradiological signs, laboratory features, disease severity, and pneumonia outcomes. Results: Analyzed herein were 172 CAP patients (77 had diabetes and 95 were nondiabetic). Clinical and radiological signs of pneumonia were mostly similar between the groups, except for purulent sputum, which was more prevalent among the nondiabetic patients. The laboratory results were also mostly similar. However, analysis of the outcomes and prognosis showed different results. The diabetic patients had a longer mean duration of hospital stay (8.52 days vs. 7.93 days, p = 0.015), higher median pneumonia severity based on the CURB-65 criteria (3 vs. 2, p = 0.016), and higher intensive care unit (ICU) admission requirement (22.1% vs. 7.3%, p = 0.004). Moreover, the mortality rate for the diabetic patients was nonsignificantly higher (16.8% vs. 15.7%, p = 0.453). Furthermore, the results of the logistic regression analysis showed that the diabetic patients had significantly higher odds of experiencing more severe forms of pneumonia (adjusted odds ratio (AOR): 5.77, 95% CI: 2.52–13.20), requiring ICU hospitalization (AOR: 3.56, 95% CI: 1.39–9.11), and having a longer hospital stay (AOR: 2.01, 95% CI: 1.09–3.71). In addition, although there was no significant relationship between the severity of pneumonia and the amount of glycated hemoglobin (HbA1c) in the diabetic patients (p = 0.940), the higher level of HbA1c in the nondiabetic patients was significantly correlated with a higher severity of pneumonia (p = 0.002). Conclusion: While diabetic patients with CAP have the same clinicoradiological and laboratory features as nondiabetic patients, the presence of diabetes can significantly worsen the outcomes and prognosis of pneumonia.
Anahtar Kelime: Pneumonia respiratory infection diabetes mellitus clinical prognosis

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  • 1. Jameson JL, Kasper DL, Longo DL, Fauci AS, Hauser SL et al. Harrison’s principles of internal medicine. 20th ed. New York, NY, USA: McGraw-Hill Education; 2018.
  • 2. Hespanhol V, Bárbara C. Pneumonia mortality, comorbidities matter? Pulmonology 2020; 26 (3): 123-129. https://doi. org/10.1016/j.pulmoe.2019.10.003
  • 3. Uranga A, España PP. Long-term Mortality in Community- acquired Pneumonia. Archivos de Bronconeumología 2018; 54 (8): 412-413. https://doi.org/10.1016/j.arbres.2017.12.019
  • 4. Wunderink RG, Waterer G. Advances in the causes and management of community acquired pneumonia in adults. British Medical Journal 2017; 358: j2471. https://doi. org/10.1136/bmj.j2471
  • 5. Khosh Khoy MKK, Valavi E. Comparison of clinical, laboratory and radiological characteristics in hospitalized diabetic and non diabetic patients with community acquired pneumonia. Jundishapur Scientific Medical Journal 2013; 11 (6): 587-595 (in Persian).
  • 6. Troeger C, Blacker B, Khalil IA, Rao PC, Cao J et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Infectious Diseases 2018; 18 (11): 1191-1210. https://doi.org/10.1016/S1473- 3099(18)30310-4
  • 7. Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Type 2 diabetes and its impact on the immune system. Current Diabetes Reviews 2020; 16 (5): 442-449. https://doi.org/10.2174 /1573399815666191024085838
  • 8. Nitzan O, Elias M, Chazan B, Saliba W. Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Diabetes, Metabolic Syndrome and Obesity 2015; 8: 129-136. https://doi.org/10.2147/DMSO. S51792
  • 9. Pozzilli P, Leslie RD. Infections and diabetes: mechanisms and prospects for prevention. Diabetic Medicine 1994; 11 (10): 935- 941. https://doi.org/10.1111/j.1464-5491.1994.tb00250.x
  • 10. Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian Journal of Endocrinology and Metabolism 2012; 16 (1): S27-S36. https:// doi.org/10.4103/2230-8210.94253
  • 11. Carey IM, Critchley JA, DeWilde S, Harris T, Hosking FJ et al. Risk of infection in type 1 and type 2 diabetes compared with the general population: a matched cohort study. Diabetes Care 2018; 41 (3): 513-521. https://doi.org/10.2337/dc17-2131
  • 12. Norouzi M, Norouzi S, Ruggiero A, Khan MS, Myers S et al. Type-2 diabetes as a risk factor for severe COVID-19 infection. Microorganisms 2021; 9 (6): 1211. https://doi.org/10.3390/ microorganisms9061211
  • 13. Vargas-Vázquez A, Bello-Chavolla OY, Ortiz-Brizuela E, Campos-Muñoz A, Mehta R et al. Impact of undiagnosed type 2 diabetes and pre-diabetes on severity and mortality for SARS- CoV-2 infection. BMJ Open Diabetes Research and Care 2021; 9 (1): e002026. https://doi.org/10.1136/bmjdrc-2020-002026
  • 14. Falguera M, Pifarre R, Martin A, Sheikh A, Moreno A. Etiology and outcome of community-acquired pneumonia in patients with diabetes mellitus. Chest 2005; 128 (5): 3233-3239. https:// doi.org/10.1378/chest.128.5.3233
  • 15. Momen-Heravi M, Razzaghi R, Mousavi SGA, Zamani-Fard S. Factors affecting the outcome of community-acquired pneumonia among the patients hospitalized in Beheshti hospital (Kashan-Iran). KAUMS Journal (FEYZ) 2017; 21 (2) :197-205 (in Persian).
  • 16. Rueda AM, Ormond M, Gore M, Matloobi M, Giordano TP et al. Hyperglycemia in diabetics and non-diabetics: effect on the risk for and severity of pneumococcal pneumonia. Journal of Infection 2010; 60 (2): 99-105. https://doi.org/10.1016/j. jinf.2009.12.003
  • 17. Chen LK, Peng LN, Lin MH, Lai HY, Lin HC et al. Diabetes mellitus, glycemic control, and pneumonia in long-term care facilities: a 2-year, prospective cohort study. Journal of the American Medical Directors Association 2011; 12 (1): 33-37. https://doi.org/10.1016/j.jamda.2010.01.010
  • 18. Ibrahem RA, El Najjar M, Korani MA. Diabetes mellitus prevalence and burden among community acquired pneumonia patients. International Journal of Public Health 2018; 7 (1): 8-12. https://doi.org/10.11591/ijphs.v7i1.10049
  • 19. Arias Fernandez L, Pardo Seco J, Cebey-López M, Gil Prieto R, Rivero-Calle I et al. Differences between diabetic and non- diabetic patients with community-acquired pneumonia in primary care in Spain. BMC Infectious Diseases 2019; 19: 1-7. https://doi.org/10.1186/s12879-019-4534-x
  • 20. Kornum JB, Thomsen RW, Riis A, Lervang HH, Schønheyder HC et al. Type 2 diabetes and pneumonia outcomes: a population-based cohort study. Diabetes Care 2007; 30 (9): 2251-2257. https://doi.org/10.2337/dc06-2417
  • 21. Bhambar S, Deore P, Rathod R, Janrao S. Pneumonia in diabetics: clinico-bacteriological profile and outcome. International Journal of Medical and Health Research 2017; 3 (6): 62-66.
  • 22. Saibal MA, Rahman SH, Nishat L, Sikder NH, Begum SA et al. Community acquired pneumonia in diabetic and non-diabetic hospitalized patients: presentation, causative pathogens and outcome. Bangladesh Medical Research Council Bulletin 2012; 38 (3): 98-103. https://doi.org/10.3329/bmrcb.v38i3.14336
  • 23. Kornum JB, Thomsen RW, Riis A, Lervang HH, Schønheyder HC et al. Diabetes, glycemic control, and risk of hospitalization with pneumonia: a population-based case-control study. Diabetes Care 2008; 31 (8): 1541-1545. https://doi.org/10.2337/ dc08-0138
  • 24. Hirata Y, Tomioka H, Sekiya R, Yamashita S, Kaneda T et al. Association of hyperglycemia on admission and during hospitalization with mortality in diabetic patients admitted for pneumonia. Internal Medicine 2013; 52 (21): 2431-2438. https://doi.org/10.2169/internalmedicine.52.9594
  • 25. Liu B, Chen Y, Yu L, Zhou M. Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission. Journal of Diabetes 2023; 15 (7): 545-556. https://doi.org/10.1111/1753- 0407.13398
  • 26. Akbar DH. Bacterial pneumonia: comparison between diabetics and non-diabetics. Acta Diabetologica 2001; 38: 77- 82. https://doi.org/10.1007/s005920170017
  • 27. Barmanray RD, Cheuk N, Fourlanos S, Greenberg PB, Colman PG et al. In-hospital hyperglycemia but not diabetes mellitus alone is associated with increased in-hospital mortality in community-acquired pneumonia (CAP): A systematic review and meta-analysis of observational studies prior to COVID-19. BMJ Open Diabetes Research and Care 2022; 10 (4): e002880. https://doi.org/10.1136/bmjdrc-2022-002880
APA Hashemi S, Saki F, Borzouei S, Bawand R, Soltanian A (2023). Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients. , 1776 - 1785. 10.55730/1300-0144.5747
Chicago Hashemi Seyyed Hamid,Saki Fatemeh,Borzouei Shiva,Bawand Rashed,Soltanian Ali Reza Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients. (2023): 1776 - 1785. 10.55730/1300-0144.5747
MLA Hashemi Seyyed Hamid,Saki Fatemeh,Borzouei Shiva,Bawand Rashed,Soltanian Ali Reza Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients. , 2023, ss.1776 - 1785. 10.55730/1300-0144.5747
AMA Hashemi S,Saki F,Borzouei S,Bawand R,Soltanian A Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients. . 2023; 1776 - 1785. 10.55730/1300-0144.5747
Vancouver Hashemi S,Saki F,Borzouei S,Bawand R,Soltanian A Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients. . 2023; 1776 - 1785. 10.55730/1300-0144.5747
IEEE Hashemi S,Saki F,Borzouei S,Bawand R,Soltanian A "Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients." , ss.1776 - 1785, 2023. 10.55730/1300-0144.5747
ISNAD Hashemi, Seyyed Hamid vd. "Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients". (2023), 1776-1785. https://doi.org/10.55730/1300-0144.5747
APA Hashemi S, Saki F, Borzouei S, Bawand R, Soltanian A (2023). Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients. Turkish Journal of Medical Sciences, 53(6), 1776 - 1785. 10.55730/1300-0144.5747
Chicago Hashemi Seyyed Hamid,Saki Fatemeh,Borzouei Shiva,Bawand Rashed,Soltanian Ali Reza Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients. Turkish Journal of Medical Sciences 53, no.6 (2023): 1776 - 1785. 10.55730/1300-0144.5747
MLA Hashemi Seyyed Hamid,Saki Fatemeh,Borzouei Shiva,Bawand Rashed,Soltanian Ali Reza Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients. Turkish Journal of Medical Sciences, vol.53, no.6, 2023, ss.1776 - 1785. 10.55730/1300-0144.5747
AMA Hashemi S,Saki F,Borzouei S,Bawand R,Soltanian A Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients. Turkish Journal of Medical Sciences. 2023; 53(6): 1776 - 1785. 10.55730/1300-0144.5747
Vancouver Hashemi S,Saki F,Borzouei S,Bawand R,Soltanian A Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients. Turkish Journal of Medical Sciences. 2023; 53(6): 1776 - 1785. 10.55730/1300-0144.5747
IEEE Hashemi S,Saki F,Borzouei S,Bawand R,Soltanian A "Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients." Turkish Journal of Medical Sciences, 53, ss.1776 - 1785, 2023. 10.55730/1300-0144.5747
ISNAD Hashemi, Seyyed Hamid vd. "Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients". Turkish Journal of Medical Sciences 53/6 (2023), 1776-1785. https://doi.org/10.55730/1300-0144.5747