糖尿病合并社区获得性肺炎住院患者临床特征和死亡危险因素分析

The clinical characteristics of hospitalized diabetic patients with community-acquired pneumonia and the risk factors for mortality

目的分析DM合并社区获得性肺炎(CAP)住院患者的临床特征和影响30 d病死率的危险因素。方法选取2013年1月至2015年12月于北京、山东、云南3省市共4所医院住院的所有CAP患者病例资料,比较DM合并CAP(DM+组)和单纯CAP(CAP组)患者临床特征和结局。Logistic回归分析DM+CAP组30 d死亡相关的独立危险因素。结果3366例CAP患者纳入研究,DM合并CAP患者531例(15.8%)。与CAP组比较,DM+CAP组CURB-65评分2~5分(28.5%vs 14.3%,P<0.001)、肺炎严重性指数Ⅲ-Ⅴ级(60.8%vs 35.5%,P=0.003)患者比例及30 d病死率(5.6%vs 2.7%,P=0.001)升高。Logistic回归分析显示,动脉血乳酸(OR 2.993,95%CI1.316,6.809,P=0.009)和血肌酐(OR 1.009,95%CI 1.002,1.016,P=0.018)是影响DM+CAP组30 d病死率的独立危险因素。结论合并DM导致CAP住院患者病情加重,临床结局恶化。临床治疗应注意保护肾功能和改善组织灌注,以提高DM合并CAP住院患者的生存率。

Objectives To explore the clinical characteristics of hospitalized diabetic patients with community-acquired pneumonia(CAP)and the risk factors for 30-day mortality.Methods Data of hospi-talized patients with CAP were collected from four tertiary hospitals in Beijing,Shandong and Yunnan provinces during January 2013 to December 2015.Clinical features and outcomes were compared between patients with and without CAP(DM+CAP group and CAP group).Logistic regression analyses were performed to evaluate the independent risk factors for 30-day mortality in patients with DM and CAP.Results Totally 3366 hospitalized patients with CAP were enrolled in this study.Among them,531(15.8%)patients were DM+CAP.Compared with CAP group,there were more patients classified as CURB-65 score 2~5(28.5%vs 14.3%,P<0.001)and Pneumonia Illness Index classⅢ-Ⅴ(60.8%vs35.5%,P=0.003)in DM+CAP group.And the 30-day mortality was significantly higher in DM+CAP group than in CAP group(5.6%vs 2.7%,P=0.001).Logistic regression analysis showed that the arterial blood lactate(OR 2.993,95%CI 1.316,6.809,P=0.009)and serum creatinine(OR 1.009,95%CI1.002,1.016,P=0.018)were independent risk factors for 30-day mortality in patients with DM+CAP.Conclusion Diabetes mellitus increased the illness severity and worsened the clinical outcomes of CAP patients.In clinic,we should pay attention in protecting renal function and improving tissue perfusion in order to enhance the survival rate of DM+CAP patients.