Incidence and outcomes of hospitalization for community-acquired, ventilator-associated and non-ventilator hospital-acquired pneumonias in patients with type 2 diabetes mellitus in Spain

Abstract

IntroductionTo describe the incidence and compare in-hospital outcomes of community-acquired pneumonia (CAP), ventilator-associated pneumonia (VAP) and non-ventilator hospital-acquired pneumonia (NV-HAP) among patients with or without type 2 diabetes mellitus (T2DM) using propensity score matching.Research design and methodsThis was a retrospective observational epidemiological study using the 2016–2017 Spanish Hospital Discharge Records.ResultsOf 245 221 admissions, CAP was identified in 227 524 (27.67% with T2DM), VAP was identified in 2752 (18.31% with T2DM) and NV-HAP was identified in 14 945 (25.75% with T2DM). The incidence of pneumonia was higher among patients with T2DM (CAP: incidence rate ratio (IRR) 1.44, 95% CI 1.42 to 1.45; VAP: IRR 1.24, 95% CI 1.12 to 1.37 and NV-HAP: IRR 1.38, 95% CI 1.33 to 1.44). In-hospital mortality (IHM) for CAP was 12.74% in patients with T2DM and 14.16% in matched controls (p<0.001); in patients with VAP and NV-HAP, IHM was not significantly different between those with and without T2DM (43.65% vs 41.87%, p=0.567, and 29.02% vs 29.75%, p=0.484, respectively). Among patients with T2DM, older age and dialysis were factors associated with IHM for all types of pneumonia. In patients with VAP, the risk of IHM was higher in females (OR 1.95, 95% CI 1.28 to 2.96).ConclusionThe incidence rates of all types of pneumonia were higher in patients with T2DM. Higher mortality rates in patients with T2DM with any type of pneumonia were associated with older age, comorbidities and dialysis.

Sex-Related Disparities in the Incidence and Outcomes of Community-Acquired Pneumonia among Type 2 Diabetes Patients: A Propensity Score-Matching Analysis Using the Spanish National Hospital Discharge Database for the Period 2016–2019

“…The results of the present study indicate that during admission for CAP, men and women with T2DM received non-invasive mechanical ventilation more frequently than matched non-T2DM men and women. The overuse of non-invasive mechanical ventilation among people with diabetes has been described previously [7,10]. In a study about mechanical ventilation use in 56,158 patients with CAP who received ventilator support, the authors found an increase in the prevalence of comorbidities over time that could partially explain the higher need for ventilatory support [30].…”

“…The PSM was conducted using multivariable logistic regression in which the matching variables were age, sex, and comorbid conditions present at admission. These methods have been described in detail elsewhere [7].…”

“…Several studies indicate that male sex is a significant risk factor for mortality after CAP [11,12]; however, other authors conclude that male sex is not a significant risk factor for CAP [13]. Results have been described in patients with diabetes that are similar to results found in the general population [7,10]; however, data regarding the results of hospitalization after CAP among men and women with diabetes are scarce.…”

“…Campling et al [6] found that patients with T2DM have a significantly higher risk of hospital admission for CAP (OR 1.18; 95% CI 1.13-1.23). In Spain, approximately 12% of patients with T2DM admitted to hospital with a first diagnosis of pneumonia die in hospital [7].…”

Relationships between peripheral reactive hyperemia index with coronary plaque burden and prognosis in patients with unstable angina pectoris complicated with type 2 diabetes mellitus

“…Type 2 diabetes mellitus (T2DM) is becoming more prevalent, especially in younger populations, as dietary and lifestyle habits change (1)(2)(3)(4). Since T2DM is often asymptomatic in its early stages, many patients have poor compliance to treatment.…”