Impact of type 2 diabetes on the course and outcomes of community-acquired pneumonia in hospitalized patients

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Aim

To evaluate the clinical features, course and outcomes of community-acquired pneumonia (CAP) in hospitalized patients with type 2 diabetes.

Material and methods

We studied 120 hospitalized patients with CAP (52.5% female, average age 61.6±11.8 years). Fifty four of them had established type 2 diabetes.

Results

Diabetic patients were characterized by older age (p=0.002), more common severe CAP and various comorbidities (arterial hypertension, coronary artery disease, heart failure, chronic kidney disease, a history of myocardial infarction and stroke), less common acute onset of the disease, and lower blood leukocytes, neutrophils and lymphocytes counts. Empiric antibiotic therapy for CAP was less effective in patients with type 2 diabetes (46.3% vs. 74.2%, p=0.002). Gram-negative bacteria predominated in diabetic patients both with monoinfection (p=0.01) and mixed infection (p=0.011), whereas gram-positive bacteria were more common in non-diabetic patients. Acute non-diabetic complications developed more frequently in patiehts with type 2 diabetes (29.6% vs 9.1%, p=0.004). Acute diabetic complications developed in 29.6% of cases. Hospital mortality was similar in diabetic and non-diabetic patients with CAP (3.7% vs. 3.0%). However, at 12-month follow-up all-cause mortality was higher in patients with type 2 diabetes (18.5% vs. 3.0%, p=0.006) .

Conclusion

Diabetic patients with CAP constitute highrisk group, given frequent comorbidities and a higher risk of severe CAP, acute complications and mortality within one year after treatment.

Key words

Community-acquired pneumonia, type 2 diabetes, decompensation of carbohydrate metabolism, infections.