Patients With Diabetes Mellitus Have Worse Pneumonia Outcomes

Results from a retrospective, nationwide analysis of more than 157,000 Portuguese patients hospitalized for community-acquired pneumonia showed that those with diabetes were more likely to be hospitalized, had longer hospital stays, and had higher mortality than adults who did not have diabetes.

Carlos Penha-Gonçalves, PhD, of Instituto Gulbenkian de Ciência in Lisbon, Portugal and other researchers reviewed data collected by the Central Administration of the Health System of the Portuguese Ministry of Health on all patients hospitalized for community-acquired pneumonia (CAP) from 2009 to 2012. After applying the exclusion criteria and selecting the target age range of 20 to 79, the researchers analyzed data on 74,175 CAP hospitalizations.

The percentage of patients with diabetes mellitus admitted for CAP was more than double the estimated population of people with diabetes in Portugal. Roughly 26% (n=19,212) of those hospitalized for CAP had diabetes.

The proportion of patients with diabetes hospitalized for CAP increased from 23.7% in 2009 to 28.1% in 2012. Researchers noted that the increase could be due in part to an aging patient population; the percentage of patients aged 60 to 79 increased from 67.5% in 2009 to 75.4% in 2012.

Patients with diabetes had consistently longer hospital stays, staying an additional 0.8 to 1.0 days. The researchers explained that added up to an extra 15,370 days of stay attributable to diabetes in more than 19,000 incidents.

Penha-Gonçalves et al. observed an increased risk for mortality for patients with diabetes (15.2% vs 13.5%), but noted that the trend only existed the youngest patients, aged 20 to 39, possibly due to their small numbers. This age cohort represented just 1.2% of the total patient population.

“It is unclear from the study the reasons behind increased in hospital mortality of CAP among patients with diabetes since it is a database study. However, it is known that complications of CAP are more common and severe in diabetic than non-diabetic patients,” Mazen S. Bader, MD, MPH, a staff physician at Hamilton Health Sciences in Hamilton, Ontario, said in an email interview. “Patients with diabetes are at higher risk for CAP and its complications due to impaired lung function, pulmonary microangiopathy. and coexisting morbidities. That said, patients with diabetes who have CAP should not be treated differently from patients without diabetes. The Infectious Diseases Society of America-recommended empiric antibiotic therapy for CAP is applicable to patients with and without diabetes since the microbiology is the same. However, patients with diabetes might need additional care for better glycemic control and management of other accompanied comorbidities.”

Disclosures: Dr. Bader had no disclosures.

Reference

1. Martins B, Boavida JM, Froes F, et al. Diabetes hinders community-acquired pneumonia outcomes in hospitalized patients. BMJ Open Diabetes Res Care. 2016;4:e000181.