Risk prediction of in-hospital mortality among patients with type 2 diabetes mellitus and concomitant community-acquired pneumonia
Cheng Sijun, Guangjian Hou, Zhipeng Liu, Ye Lu, Sicong Liang, Lin Cang, Xinyue Zhang, Cunlu Zou, Jian Kang, Yu Chen
Abstract
BACKGROUND: The aim of the present study was to investigate the risk factors for in-hospital mortality among patients with type 2 diabetes mellitus (T2DM) and concomitant community-acquired pneumonia (CAP) and establish a risk prediction score. METHODS: Data from 1,360 adult patients with T2DM and concomitant CAP hospitalized in two grade 3A hospitals between 2009 and 2019 were collected through electronic medical records. Data obtained included the status of diabetes mellitus, comorbidities, laboratory and imaging findings, and treatment outcomes. Statistical analysis was conducted to investigate the risk factors affecting prognosis, and a clinical risk prediction score was designed. RESULTS: Based on the patients' treatment outcomes (deceased, improved and cured), the cohort was divided into two groups: deceased and improved; 16 parameters were significant after segmentation. However, the following nine parameters were independent predictors of mortality: neutrophil-lymphocyte ratio (NLR) ≥4, pulse rate ≥125 bpm, change in state of consciousness, arterial blood pH ≤7.35, age ≥65 years, serum sodium ≤130 mmol/L, initial fasting blood glucose ≥9 mmol/L, multilobar involvement, and diabetic nephropathy. Based on these findings, a risk prediction score was established, and bootstrap validation was performed. The risk prediction score was significantly superior to CURB-65 [confusion, urea >7 mmol/L, respiratory rate >30/min, low blood pressure (systolic <90 mmHg or diastolic <60 mmHg), age >65 years] and slightly superior than the pneumonia severity index (PSI). CONCLUSIONS: The influencing factors for in-hospital mortality among patients with T2DM and concomitant CAP included advanced age, change in state of consciousness, increased pulse rate, acidosis, high NLR, high platelet-lymphocyte ratio, hyponatremia, hyperglycemia, and diabetic nephropathy. These parameters should be recognized in clinical practice, with active interventions to improve the treatment success rate. The risk prediction score effectively differentiated the mortality risk of inpatients, thereby providing guidance on clinical decision-making.