2 型糖尿病与术后肺炎：基于西班牙住院患者数据库的观察性研究，2001-2015 年。
Type 2 diabetes and postoperative pneumonia: An observational, population-based study using the Spanish Hospital Discharge Database, 2001-2015.
机构信息
Preventive Medicine and Public Health Teaching and Research Unit. Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
Public Health and Psychiatry Department, Faculty of Medicine, Universidad de Malaga, Malaga, Spain.
出版信息
PLoS One. 2019 Feb 6;14(2):e0211230. doi: 10.1371/journal.pone.0211230. eCollection 2019.
PURPOSE
We analyzed temporal trends, demographic and clinical characteristics and hospital mortality rates of postoperative pneumonia among type 2 diabetes mellitus (T2DM) patients in Spain from 2001 to 2015. We also compared the incidence, comorbidities and mortality between patients with and without T2DM suffering from postoperative pneumonia. Finally, we analyzed the factors involved in the prediction of in-hospital mortality among patients suffering postoperative pneumonia.
METHODS
We used the Spanish National Hospital Discharge Database for the period 2001-2015. We analyzed patients aged 40 years or over who had been hospitalized for a surgical procedure and suffered pneumonia or ventilator-associated pneumonia during their hospital admission. We compared patients with and without T2DM. The main outcome measures were the type of surgical procedure, the presence of a comorbidity, the type of isolated pathogens, admission to the emergency room (ER) and in-hospital mortality (IHM).
RESULTS
We selected 117,665 hospitalized patients who suffered postoperative pneumonia (16.9% with T2DM). After multivariable adjustment, T2DM patients had a 21% higher incidence of postoperative pneumonia than nondiabetic patients (IRR 1.21, 95% CI 1.03-1.42). The IHM was approximately 31% in both groups. Predictors of IHM included age, the presence of comorbidities, treatment with a pleural drainage tube, dialysis, blood transfusion, mechanical ventilation and admission to the ER. From 2001 to 2015, the IHM decreased significantly in both populations. Suffering from T2DM was not a predictor of IHM (OR 0.99, 95% CI 0.96-1.03) in our investigation.
CONCLUSIONS
T2DM patients have a higher incidence of postoperative pneumonia than those without this disease. The IHM decreased from 2001 to 2015, regardless of T2DM status. T2DM did not predict a higher IHM after suffering from postoperative pneumonia.
目的
我们分析了 2001 年至 2015 年期间西班牙 2 型糖尿病（T2DM）患者术后肺炎的时间趋势、人口统计学和临床特征以及住院死亡率。我们还比较了患有和不患有 T2DM 的术后肺炎患者的发病率、合并症和死亡率。最后，我们分析了预测术后肺炎患者住院死亡率的相关因素。
方法
我们使用了 2001 年至 2015 年期间的西班牙国家住院患者数据库。我们分析了年龄在 40 岁或以上的因手术住院且在住院期间患有肺炎或呼吸机相关性肺炎的患者。我们比较了患有和不患有 T2DM 的患者。主要观察指标是手术类型、合并症的存在、分离病原体的类型、急诊室（ER）入院和住院死亡率（IHM）。
结果
我们选择了 117665 例患有术后肺炎的住院患者（16.9%患有 T2DM）。经过多变量调整后，T2DM 患者术后肺炎的发病率比非糖尿病患者高 21%（IRR 1.21，95%CI 1.03-1.42）。两组的 IHM 约为 31%。IHM 的预测因素包括年龄、合并症的存在、使用胸腔引流管治疗、透析、输血、机械通气和 ER 入院。从 2001 年到 2015 年，两组的 IHM 均显著下降。在我们的研究中，患有 T2DM 并不是 IHM 的预测因素（OR 0.99，95%CI 0.96-1.03）。
结论
T2DM 患者术后肺炎的发病率高于无该疾病的患者。从 2001 年到 2015 年，无论 T2DM 状况如何，IHM 均呈下降趋势。患有术后肺炎后，T2DM 并不能预测更高的 IHM。
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