严重社区获得性肺炎合并 2 型糖尿病患者的临床特征及与死亡相关的危险因素。
Clinical characteristics and risk factors associated with mortality in patients with severe community-acquired pneumonia and type 2 diabetes mellitus.
机构信息
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
Institute of Clinical Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
出版信息
Crit Care. 2021 Dec 7;25(1):419. doi: 10.1186/s13054-021-03841-w.
BACKGROUND
The present study was performed to investigate the impacts of type 2 diabetes mellitus (T2DM) on severe community-acquired pneumonia (SCAP) and to develop a novel prediction model for mortality in SCAP patients with T2DM.
METHODS
This was a retrospective observational study conducted in consecutive adult patients with SCAP admitted to the intensive care unit (ICU) of West China Hospital, Sichuan University, China, between September 2011 and September 2019. The primary outcome was hospital mortality. A propensity score matching (PSM) analysis model with a 1:2 ratio was used for the comparisons of clinical characteristics and outcomes between T2DM and nondiabetic patients. The independent risk factors were identified via univariate and then multivariable logistic regression analysis and were then used to establish a nomogram.
RESULTS
In total, 1262 SCAP patients with T2DM and 2524 matched patients without T2DM were included after PSM. Patients with T2DM had longer ICU length of stay (LOS) (13 vs. 12 days, P = 0.016) and higher 14-day mortality (15% vs. 10.8%, P < 0.001), 30-day mortality (25.7% vs. 22.7%, P = 0.046), ICU mortality (30.8% vs. 26.5%, P = 0.005), and hospital mortality (35.2% vs. 31.0%, P = 0.009) than those without T2DM. In SCAP patients with T2DM, the independent risk factors for hospital mortality were increased numbers of comorbidities and diabetes-related complications; elevated C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), brain natriuretic peptide (BNP) and blood lactate; as well as decreased blood pressure on admission. The nomogram had a C index of 0.907 (95% CI: 0.888, 0.927) in the training set and 0.873 (95% CI: 0.836, 0.911) in the testing set, which was superior to the pneumonia severity index (PSI, AUC: 0.809, 95% CI: 0.785, 0.833). The calibration curve and decision curve analysis (DCA) also demonstrated its accuracy and applicability.
CONCLUSIONS
SCAP patients with T2DM had worse clinical outcomes than nondiabetic patients. The nomogram has good predictive performance for hospital mortality and might be generally applied after more external validations.
背景
本研究旨在探讨 2 型糖尿病（T2DM）对重症社区获得性肺炎（SCAP）的影响，并为合并 T2DM 的 SCAP 患者死亡率建立一种新的预测模型。
方法
这是一项回顾性观察性研究，连续纳入 2011 年 9 月至 2019 年 9 月期间在中国四川大学华西医院重症监护病房（ICU）收治的 SCAP 成年患者。主要结局为住院死亡率。采用倾向性评分匹配（PSM）分析模型，以 1:2 的比例比较 T2DM 患者和非糖尿病患者的临床特征和结局。通过单因素和多因素逻辑回归分析确定独立的危险因素，并用于建立列线图。
结果
PSM 后共纳入 1262 例合并 T2DM 的 SCAP 患者和 2524 例匹配的无 T2DM 患者。T2DM 患者的 ICU 住院时间（LOS）更长（13 天 vs. 12 天，P=0.016），14 天死亡率（15% vs. 10.8%，P<0.001）、30 天死亡率（25.7% vs. 22.7%，P=0.046）、ICU 死亡率（30.8% vs. 26.5%，P=0.005）和住院死亡率（35.2% vs. 31.0%，P=0.009）均高于非糖尿病患者。在合并 T2DM 的 SCAP 患者中，医院死亡率的独立危险因素包括合并症和糖尿病相关并发症的数量增加；C 反应蛋白（CRP）、中性粒细胞与淋巴细胞比值（NLR）、脑钠肽（BNP）和血乳酸升高；入院时血压降低。列线图在训练集中的 C 指数为 0.907（95%CI：0.888，0.927），在验证集中为 0.873（95%CI：0.836，0.911），优于肺炎严重指数（PSI，AUC：0.809，95%CI：0.785，0.833）。校准曲线和决策曲线分析（DCA）也表明了其准确性和适用性。
结论
合并 T2DM 的 SCAP 患者临床结局较非糖尿病患者更差。该列线图对医院死亡率具有良好的预测性能，可能需要进一步的外部验证后才能广泛应用。
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