Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Laboratory, University of Pittsburgh, Pittsburgh, PA, USA.
Thorax. 2010 Oct;65(10):870-7. doi: 10.1136/thx.2010.136317.
Although diabetes mellitus is implicated in susceptibility to infection, the association of diabetes with the subsequent course and outcome is unclear.
A retrospective analysis of two multicentre cohorts was carried out. The effect of pre-existing diabetes on the host immune response, acute organ function and mortality in patients hospitalised with community-acquired pneumonia (CAP) in the GenIMS study (n=1895) and on mortality following either CAP or non-infectious hospitalisations in the population-based cohort study, Health ABC (n=1639) was determined. Measurements included the mortality rate within the first year, risk of organ dysfunction, and immune responses, including circulating inflammatory (tumour necrosis factor, interleukin 6, interleukin 10), coagulation (Factor IX, thrombin-antithrombin complexes, antithrombin), fibrinolysis (plasminogen-activator inhibitor-1 and D-dimer) and cell surface markers (CD120a, CD120b, human leucocyte antigen (HLA)-DR, Toll-like receptor-2 and Toll-like receptor-4).
In GenIMS, diabetes increased the mortality rate within the first year after CAP (unadjusted HR 1.41, 95% CI 1.12 to 1.76, p=0.002), even after adjusting for pre-existing cardiovascular and renal disease (adjusted HR 1.3, 95% CI 1.03 to 1.65, p=0.02). In Health ABC, diabetes increased the mortality rate within the first year following CAP hospitalisation, but not after hospitalisation for non-infectious illnesses (significant interaction for diabetes and reason for hospitalisation (p=0.04); HR for diabetes on mortality over the first year after CAP 1.87, 95% CI 0.76 to 4.6, p=0.16, and after non-infectious hospitalisation 1.16, 95% CI 0.8 to 1.6, p=0.37). In GenIMS, immediate immune response was similar, as evidenced by similar circulating immune marker levels, in the emergency department and during the first week. Those with diabetes had a higher risk of acute kidney injury during hospitalisation (39.3% vs 31.7%, p=0.005) and they were more likely to die due to cardiovascular and kidney disease (34.4% vs 26.8% and 10.4% vs 4.5%, p=0.03).
Pre-existing diabetes was associated with a higher risk of death following CAP. The mechanism is not due to an altered immune response, at least as measured by a broad panel of circulating and cell surface markers, but may be due to worsening of pre-existing cardiovascular and kidney disease.
尽管糖尿病与易感性感染有关，但糖尿病与随后的病程和结局的关系尚不清楚。
对两项多中心队列进行了回顾性分析。在 GenIMS 研究（n=1895）中，确定了既往糖尿病对社区获得性肺炎（CAP）住院患者的宿主免疫反应、急性器官功能和死亡率的影响，以及在基于人群的队列研究 Health ABC（n=1639）中 CAP 或非传染性住院后的死亡率。测量包括第一年的死亡率、器官功能障碍风险以及免疫反应，包括循环炎症（肿瘤坏死因子、白细胞介素 6、白细胞介素 10）、凝血（因子 IX、凝血酶-抗凝血酶复合物、抗凝血酶）、纤维蛋白溶解（纤溶酶原激活物抑制剂-1 和 D-二聚体）和细胞表面标志物（CD120a、CD120b、人类白细胞抗原（HLA）-DR、Toll 样受体-2 和 Toll 样受体-4）。
在 GenIMS 中，糖尿病增加了 CAP 后第一年的死亡率（未调整的 HR 1.41，95%CI 1.12 至 1.76，p=0.002），即使在调整了预先存在的心血管和肾脏疾病后也是如此（调整后的 HR 1.3，95%CI 1.03 至 1.65，p=0.02）。在 Health ABC 中，糖尿病增加了 CAP 住院后第一年的死亡率，但在非传染性疾病住院后没有增加（糖尿病和住院原因之间的显著交互作用（p=0.04）；CAP 后第一年糖尿病死亡率的 HR 为 1.87，95%CI 0.76 至 4.6，p=0.16，非传染性住院后为 1.16，95%CI 0.8 至 1.6，p=0.37）。在 GenIMS 中，立即的免疫反应是相似的，这从急诊科和第一周相似的循环免疫标志物水平可以看出。患有糖尿病的患者在住院期间发生急性肾损伤的风险更高（39.3%比 31.7%，p=0.005），并且因心血管和肾脏疾病而死亡的可能性更高（34.4%比 26.8%和 10.4%比 4.5%，p=0.03）。
既往糖尿病与 CAP 后死亡风险增加有关。其机制不是由于免疫反应改变，至少从广泛的循环和细胞表面标志物测量来看是这样，但可能是由于预先存在的心血管和肾脏疾病恶化所致。
