Etiology and outcome of community-acquired pneumonia in patients with diabetes mellitus
Etiology and outcome of community-acquired pneumonia in patients with diabetes mellitus
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DOI：
10.1378/chest.128.5.3233
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发表时间：
2005-11-01
期刊：
影响因子：
9.6
通讯作者：
Moreno, A
中科院分区：
文献类型：
--
作者：
Falguera, K;Pifarre, R;Moreno, A
研究目的：研究表明糖尿病与感染的易感性增加、使用更积极的治疗药物的风险以及并发症和死亡率的增加有关；然而，目前在肺炎领域支持这些事件的证据很少。本研究的目的是提供糖尿病患者社区获得性肺炎的临床和微生物学特征及转归的信息。设计：前瞻性研究病例。背景：西班牙莱达的一所大学医院。患者：在5年的时间里，我们前瞻性地研究了临床和放射学特征、病原谱和其他微生物学数据，以及连续660例社区获得性肺炎的转归。对106名糖尿病患者的数据进行了分析，并与其余人群的数据进行了比较。测量和结果：糖尿病患者明显年龄较大(p=0.001)，且更容易合并其他疾病(p=0.018)。糖尿病的发病率也很高。与胸腔积液的发生(p=0.015)和死亡率(p=0.002)有关；在多变量分析中，糖尿病仍然是一个独立的预测因素。相比之下，主要病原菌的发生率以及菌血症或脓胸的发生率与其余患者没有显著差异。在糖尿病患者亚组中，死亡率与多叶浸润性病变(p=0.004)、伴发基础疾病(p=0.004)和某些糖尿病相关并发症(肾病，p=0.040；血管病变，p=0.002)有关，尽管在多因素分析中只选择多叶浸润性病变和合并症作为预后因素。结论：在社区获得性肺炎患者中，糖尿病与预后不良有关，增加了胸腔积液和死亡率。我们的结果表明，这种不良结果更多地归因于患者的潜在环境，而不是罕见的微生物发现。
Study objectives: It has been suggested that diabetes mellitus is associated with an increased susceptibility to infection, the risk of using more aggressive therapeutic agents, and increased niorbidity and mortality; however, current evidence supporting these events in the field of pneumonia is scarce. The aim of the present study was to provide information on clinical and microbiological characteristics and the outcome of community-acquired pneumonia in patients with diabetes mellitus.Design: Prospective study of cases.Setting: A university hospital in Lleida, Spain.Patients: During a 5-year period, we prospectively studied the clinical and radiologic characteristics, the spectrum of causative agents and other microbiological data, and the outcomes of 660 consecutive episodes of community-acquired pneumonia. Data derived from 106 patients with diabetes mellitus were analyzed and compared with data obtained from the remaining population.Measurements and results: Patients with diabetes mellitus were significantly older (p = 0.001) and more frequently had other concomitant comorbid conditions (p = 0.018). Diabetes was also significantly. associated with the development of pleural effusion (p = 0.015) and mortality (p = 0.002); for both events, diabetes remained as an independent predictive factor in multivariate analyses. By contrast, the incidence of the main etiologic agents, and the bacteremia or empyema rates did not show significant differences in relation to the remaining patients. In the subgroup of patients with diabetes, mortality, was associated with the presence of multilobar infiltrates (p = 0.004), concomitant underlying diseases (p = 0.004), and some diabetes-related complications (nephropathy, p = 0.040; an vasculopathy, p = 0.002), although only multilobar infiltrates and comorbidities were selected as prognostic factors in the multivariate analysis.Conclusions: In patients with community-acquired pneumonia, diabetes mellitus is associated with a poor prognosis, increasing the rate of pleural effusion and mortality. Our results suggest that this adverse outcome is more attributable to the underlying circumstances of patients than to uncommon microbiological findings.