Association Of Blood Glucose Level And Patient’s Condition And Prognosis In Diabetes Patients With Community-acquired Pneumonia

Objective: 1.By analyzing the correlation between blood glucose level and the severity of type 2 diabetes combined with community-acquired pneumonia(CAP),it can provide valuable reference for clinical health care personnel to monitor the indexes and pay attention to the changes of patients’ conditions and use relevant drugs in a timely manner when treating diabetes combined with community-acquired pneumonia.2.By analyzing the influence of blood glucose control level on the condition and prognosis of patients with diabetes mellitus combined with community-acquired pneumonia,it can provide a theoretical basis for clinical medical personnel to control the blood glucose level in the diagnosis and treatment of diabetes mellitus combined with community-acquired pneumonia.3.By analyzing the poor prognostic factors in patients with diabetes mellitus with community-acquired pneumonia,we can improve the awareness of these patients about their disease and strengthen their management of poor prognostic factors.Methods:A retrospective observational study of hospital data on all patients hospitalized with community-acquired pneumonia in the Department of Respiratory Medicine at the First People’s Hospital of Wuhu City between January 2022 and December 2022.Part I: Effect of type 2 diabetes on the condition and prognosis of community-acquired pneumoniaMethods: 1.All patients with community-acquired pneumonia(CAP)were divided into two groups: CAP alone and T2 DM combined with CAP,and the clinical characteristics(major symptoms,clinical scores(PSI,CURB-65),comorbid diseases,chest CT,laboratory indices [white blood cell count(WBC),C-reactive protein(CRP),calcitoninogen(PCT),neutro/ lymphocytes,etc.],differences in clinical outcomes,and analysis of the relationship between diabetes and CAP condition and prognosis;RESULTS: A total of 444 CAP patients were enrolled.Among them,there were 129 patients with T2 DM combined with CAP,accounting for 29.1% of the total CAP.The results of independent sample t-test,Wilcoxon rank sum test and chi-square test showed that hypertension,coronary heart disease,cerebrovascular disease,chronic kidney disease,fever,cough and sputum,impaired consciousness,white blood cell count,lymphocyte count,NLR,urea nitrogen,blood sodium,first fasting glucose,Hb A1 C,calcitoninogen,CRP,multiple lung segment infection,pleural effusion,PSI score,CURB-65 score,ICU admission,length of stay,and mortality were statistically significant differences(P < 0.05).Conclusion: Patients with T2 DM and CAP have more combined diseases than those with CAP alone,and combined T2 DM can aggravate CAP,increase ICU admission,prolong hospital stay and lead to high mortality.Part II: Effect of blood glucose control level on the condition and prognosis of patients with T2 DM combined with CAPMETHODS: T2 DM combined with CAP was divided into a well-controlled group(Hb A1 c <6.1%),an average controlled group(6.1% ≤ Hb A1 c ≤9%),and a poorly controlled group(>9%)according to glycosylated hemoglobin levels.Statistical correlation of glycosylated hemoglobin levels with clinical scores(PSI,CURB),imaging features,inflammatory indicators(e.g.,CRP,PCT,neutrophils/lymphocytes),and prognosis in the three groups;RESULTS: ANOVA,Kruskal-Wallis H test and R × C chi-square test showed statistically significant differences in cerebrovascular disease,chronic kidney disease,white blood cell count,NLR,urea nitrogen,calcitoninogen,CRP,multiple lung segment infections,PSI score,CURB-65 score,ICU admission,length of stay and mortality in the three groups(P < 0.05).CONCLUSION: The effect of blood glucose level on in-hospital mortality(P = 0.011),length of stay(P < 0.01),ICU admission(P = 0.005)and severity score(P < 0.05)was statistically significant.Cerebrovascular disease and chronic kidney disease were associated with adverse outcomes.Part III: Factors influencing poor prognosis and risk prediction model of patients with T2 DM combined with CAP.METHODS: Patients with T2 DM combined with CAP were divided into good prognosis group(improved discharge)and poor prognosis group(death,abandonment of treatment,transfer to higher level hospital),and the clinical indexes of the two groups were counted,and the influencing factors of poor prognosis were analyzed univariately and multifactorially to establish the risk prediction model.RESULTS: Independent sample t-test,Wilcoxon rank sum test and chi-square test showed that the differences in age,pulse rate at admission,respiratory rate,coronary heart disease,cerebrovascular disease,chronic kidney disease,impaired consciousness,white blood cell count,NLR,urea nitrogen,first fasting glucose,calcitoninogen,CRP,multiple lung segment infection and pleural effusion between the two groups with good prognosis and poor prognosis were statistically significant(P <0.05).Respiratory rate,NLR,urea nitrogen,multi-pulmonary segment infection and combined cerebrovascular disease were independent risk factors for the prognosis of patients with T2 DM combined with CAP.Respiratory rate ≥ 30 breaths/min [OR(95% CI): 1.38(1.20,1.58)],NLR ≥ 4 [OR(95% CI): 3.72(1.80,7.67)],urea nitrogen > 11 mmol/L [OR(95% CI): 1.45(1.17,1.80)],multiple lung segment infections [OR(95% CI): 7.18(1.95,26.44)] and combined cerebrovascular disease [OR(95% CI): 4.61(1.11,19.14))],the worse the prognosis of patients with T2 DM combined with CAP(P < 0.05).And based on the findings of this paper,we constructed a prediction model.The prediction criteria of respiratory rate ≥ 30 breaths/min,NLR ≥ 4,urea nitrogen > 11mmol/L,multiple lung segment infections,and cerebrovascular disease were included.The ROC curves of poor prognosis in patients with T2 DM combined with CAP were also plotted,and the results showed that the prediction model had high predictive efficacy.CONCLUSION: Risk factors for in-hospital death in CAP inpatients with combined T2 DM included age,pulse rate at admission,respiratory rate,coronary artery disease,cerebrovascular disease,chronic kidney disease,impaired consciousness,white blood cell count,NLR,urea nitrogen,first fasting glucose,calcitoninogen,CRP,multiple pulmonary segment infections,and pleural effusion.Among these factors,respiratory rate ≥ 30 breaths/min,NLR ≥ 4,urea nitrogen > 11 mmol/L,multi-pulmonary segment infection and combined cerebrovascular disease are independent risk factors for prognosis.Active interventions on these indicators should be performed in clinical work to improve treatment success.The prediction model can also be used to identify patients with T2 DM combined with CAP who have poor prognosis and provide valuable reference for timely clinical decision making.