Department of Internal Medicine, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Korea.
Department of Economics, College of Political Science and Economics, Korea University, 145 Anam-ro, Sungbuk-gu, Seoul, 02841, Korea.
Infection. 2020 Jun;48(3):435-443. doi: 10.1007/s15010-020-01419-2. Epub 2020 Apr 16.
Diabetes mellitus has been suspected to increase mortality in acute pyelonephritis (APN) patients and the goal of this study is to verify this suspicion with a large data set based on almost the entire population of South Korea.
A nationwide cohort study was conducted using a South Korean Health Insurance Review and Assessment Service claim database. We collected demographic and clinical information including comorbidities of patients with APN as the primary discharge diagnosis during 2010-2014. Then we compared the in-hospital mortality and recurrence of APN across the diabetes and non-diabetes groups.
Among 845,656 APN patients, 12.4% had diabetes mellitus. The median age was 65 in the diabetes group, which was much higher than 47 in the non-diabetes group; the female proportion was 91-92% in both groups. The in-hospital mortality rate was higher in the diabetes group (2.6/1000 events in the diabetes group vs. 0.3/1000 in the non-diabetes group, P < 0.001). When covariates (age, sex, and the modified Charlson comorbidity index) were controlled with panel logistic regression, diabetes was still associated with a higher in-hospital mortality in APN patients (OR 2.66, 95% CI 2.19-3.23). The increasing effect of diabetes on in-hospital mortality of APN patients varied greatly with age: the effect was large for age 15-49 (OR 15.06, 95% CI 5.27-43.05), slightly smaller for age 50-64 (OR 12.17, 95% CI 5.71-25.92), and much smaller for age ≥ 65 (OR 2.10, 95% CI 1.72-1.92).
Our data indicate that the mortality of APN is higher in the patients with diabetes and this effect becomes stronger for young patients.
糖尿病已被怀疑会增加急性肾盂肾炎（APN）患者的死亡率，本研究的目的是使用基于韩国几乎全部人口的大型数据集来验证这一假设。
本研究采用韩国健康保险审查和评估服务索赔数据库进行了一项全国性队列研究。我们收集了 2010 年至 2014 年期间作为主要出院诊断的 APN 患者的人口统计学和临床信息，包括合并症。然后，我们比较了糖尿病组和非糖尿病组的住院死亡率和 APN 复发率。
在 845656 例 APN 患者中，12.4%患有糖尿病。糖尿病组的中位年龄为 65 岁，远高于非糖尿病组的 47 岁；两组的女性比例均为 91-92%。糖尿病组的住院死亡率更高（糖尿病组为 2.6/1000 例，非糖尿病组为 0.3/1000 例，P<0.001）。使用面板逻辑回归控制协变量（年龄、性别和改良 Charlson 合并症指数）后，糖尿病仍然与 APN 患者的住院死亡率升高相关（OR 2.66，95%CI 2.19-3.23）。糖尿病对 APN 患者住院死亡率的影响随年龄的变化而有很大差异：15-49 岁年龄组的影响较大（OR 15.06，95%CI 5.27-43.05），50-64 岁年龄组的影响稍小（OR 12.17，95%CI 5.71-25.92），年龄≥65 岁的影响较小（OR 2.10，95%CI 1.72-1.92）。
我们的数据表明，糖尿病患者的 APN 死亡率较高，这种影响在年轻患者中更为明显。
