Type 2 Diabetes and Pneumonia Outcomes

Abstract

OBJECTIVE -We sought to examine whether type 2 diabetes increases risk of death and complications following pneumonia and to assess the prognostic value of admission hyperglycemia.RESEARCH DESIGN AND METHODS -This was a population-based cohort study of adults with a first-time hospitalization for pneumonia between 1997 and 2004 (n ϭ 29,900) in northern Denmark. Information on diabetes, comorbidity, laboratory findings, pulmonary complications, and bacteremia was obtained from medical databases. We used regression to compute adjusted relative risks of pulmonary complications, bacteremia, and mortality rate ratios (MRRs) within 90 days following hospitalization among patients with and without type 2 diabetes. The prognostic impact of admission hyperglycemia was studied in a subcohort (n ϭ 13,574).RESULTS -In total, 2,931 (9.8%) pneumonia patients had type 2 diabetes. Mortality among diabetic patients was greater than that among other patients: 19.9 vs. 15.1% after 30 days and 27.0 vs. 21.6% after 90 days, respectively, corresponding to adjusted 30-and 90-day MRRs of 1.16 (95% CI 1.07-1.27) and 1.10 (1.02-1.18). Presence of type 2 diabetes did not predict pulmonary complications or bacteremia. Adjustment for hyperglycemia attenuated the association between type 2 diabetes and mortality. High glucose level on admission was a predictor of death among patients with diabetes and more so among those without diagnosed diabetes: adjusted 30-day MRRs for glucose level Ն14 mmol/l were 1.46 (1.01-2.12) and 1.91 (1.40 -2.61), respectively. CONCLUSIONS -Type 2 diabetes and admission hyperglycemia predict increased pneumonia-related mortality. Diabetes Care 30:2251-2257, 2007M ortality among adults hospitalized with community-acquired pneumonia (CAP) ranges from 6 to 14% (1). Advanced age and comorbidity are associated with increased mortality in these patients (2-4). Given the hyperglycemia, decreased immunity, impaired lung function, and chronic complications, such as renal failure, heart disease, and pulmonary microangiopathy, associated with diabetes (5), it is plausible that diabetes may predict increased severity of pneumonia. However, results of recent observational studies and a meta-analysis of pneumonia-related mortality, based on pre-1996 research, were inconsistent (6 -10). The discrepancies could stem from the use of clinic-based cohorts, confounding, or incomplete follow-up. Better diagnostic surveillance of diabetic patients may result in lower-than-expected mortality from pneumonia. Most studies lack data on pneumonia severity at hospitalization in diabetic versus nondiabetic patients (6,8 -10), whereas claims that diabetic pneumonia patients have an increased risk of developing bacteremia (5,11) are questionable because data on availability of blood cultures are often absent. Evidence regarding pulmonary complications in diabetic patients with pneumonia is scant (5,7), as are data on the prognostic value of acute hyperglycemia for diabetic patients with pneumonia (10).As prevalences of diabetes (12) and pneumon...

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