PMID- 34876193 OWN - NLM STAT- MEDLINE DCOM- 20220120 LR - 20220120 IS - 1466-609X (Electronic) IS - 1364-8535 (Print) IS - 1364-8535 (Linking) VI - 25 IP - 1 DP - 2021 Dec 7 TI - Clinical characteristics and risk factors associated with mortality in patients with severe community-acquired pneumonia and type 2 diabetes mellitus. PG - 419 LID - 10.1186/s13054-021-03841-w [doi] LID - 419 AB - 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. CI - (c) 2021. The Author(s). FAU - Huang, Dong AU - Huang D AD - Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China. AD - 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. FAU - He, Dingxiu AU - He D AD - Department of Emergency Medicine, The People's Hospital of Deyang, Deyang, Sichuan, China. FAU - Gong, Linjing AU - Gong L AD - Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China. AD - 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. FAU - Wang, Wen AU - Wang W AD - Chinese Evidence-Based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, Sichuan, China. FAU - Yang, Lei AU - Yang L AD - Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China. FAU - Zhang, Zhongwei AU - Zhang Z AD - Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China. FAU - Shi, Yujun AU - Shi Y AD - 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. shiyujun@scu.edu.cn. FAU - Liang, Zongan AU - Liang Z AUID- ORCID: 0000-0002-8358-9177 AD - Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China. liangza@scu.edu.cn. LA - eng GR - 82072156/National Natural Science Foundation of China/ GR - 2019YFS0443/Science and Technology Department of Sichuan Province/ GR - 2018JY0389/Science and Technology Department of Sichuan Province/ GR - 2016YFC1304303/National Key Research and Development Program of China/ PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20211207 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 SB - IM MH - Adult MH - *Community-Acquired Infections MH - *Diabetes Mellitus, Type 2/complications MH - Humans MH - *Pneumonia MH - Prognosis MH - Retrospective Studies MH - Risk Factors MH - Severity of Illness Index PMC - PMC8650350 OTO - NOTNLM OT - Clinical characteristics OT - Nomogram OT - Risk factors OT - Severe community-acquired pneumonia OT - Type 2 diabetes mellitus COIS- The authors declare that they have no competing interests. EDAT- 2021/12/09 06:00 MHDA- 2022/01/21 06:00 PMCR- 2021/12/07 CRDT- 2021/12/08 05:41 PHST- 2021/09/17 00:00 [received] PHST- 2021/11/24 00:00 [accepted] PHST- 2021/12/08 05:41 [entrez] PHST- 2021/12/09 06:00 [pubmed] PHST- 2022/01/21 06:00 [medline] PHST- 2021/12/07 00:00 [pmc-release] AID - 10.1186/s13054-021-03841-w [pii] AID - 3841 [pii] AID - 10.1186/s13054-021-03841-w [doi] PST - epublish SO - Crit Care. 2021 Dec 7;25(1):419. doi: 10.1186/s13054-021-03841-w.