| Objective:This study reviews the clinical characteristics and prognosis of the elderly community-acquired pneumonia patients with type 2 diabetes mellitus,by analyzing the general data and laboratory examinations in different situation of prognosis to provide the clinical basis for evaluating the patient's condition and prognosis.Methods:A total of 115 elderly community-acquired pneumonia patients with type 2 diabetes mellitus in the Department of Respiratory and Critical Care Medicine at the Affiliated Hospital of Southwest Medical University from January 2017 to July 2018 were admitted in this study,with 80 cases in the good prognosis and 35 cases in the poor prognosis based on the situation of the patients at the time of discharging from hospital.To analyze the general data[Name,Age,Gender,Inpatient days,Inpatient costs,Prognosis,Course of diabetes mellitus,Whether the medication is taken to control blood sugar,Height,Weight,Body Mass Index(BMI)] and laboratory examinations[Fasting Plasma Glucose(FPG),Hemoglobin A1c(Hb A1c),White Blood Cell(WBC),Neutrophil(NEU),Neutrophil Percent(Neu%),Procalcitonin(PCT),Total Cholesterol(TC),Triglyceride(TG),Low-Density Lipoprotein(LDL),High-Density Lipoprotein(HDL),Etiology and results of Imaging examinations]by using statistical methods such as Rank sum test,Student's t test,Chi-square test,Logistic regressive,Receiver operating characteristic curve.Results:This study includes 115 elderly community-acquired pneumonia patients with type 2 diabetes mellitus,54 cases of sputum culture are positive,a total of 66 cases of pathogens are collected,of which 37(56.06%)strains are gram-negative bacteria,27(40.91%)strains are fungi and 2(3.03%)strains are gram-positive bacteria,and Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae are common pathogens.According to the survival status at the time of discharge,the patients are divided into 2 groups,with 80 cases in the good prognosis and 35 cases in the poor prognosis.The comparison of the 2 groups in Whether the course of diabetes mellitus more than 10 years(?2=11.089,P=0.001),Body Mass Index(t=3.416,P=0.001),Fasting Plasma Glucose(t=5.782,P=0.001),Hemoglobin A1c(Z=5.975,P=0.001),Procalcitonin(Z=3.307,P=0.001),Low-Density Lipoprotein(t=7.148,P=0.001),High-Density Lipoprotein(Z=6.204,P=0.001)are statistically significant(P<0.05).Compared with the good prognostic group,the patients in the poor prognostic group had more diabetes courses > 10 years,the worse control of weight,blood sugar and lipids,and the higher PCT.According to the result of logistic regressive,whether the course of diabetes more than 10 years(OR=362.213,P=0.027,95%CI= 1.948-67347.453),Hb A1c(OR=16.843,P=0.015,95%CI=1.740-163.001)?LDL(OR=37.429,P=0.007,95%CI=2.677-523.368)are the risk factors for community-acquired pneumonia patients with type 2 diabetes mellitus in elderly,yet the HDL(OR=0.000,P=0.017,95%CI=0.000-0.104)is the protective factor.The receiver operating characteristic curve shows that the Area under the curve(AUC),cut-off,sensitivity,specificity of Hb A1 c,LDL,HDL are:Hb A1c:AUC 0.851,cut-off 8.75%,sensitivity 0.657,specificity 0.863;LDL:AUC 0.894,cut-off 2.53mmol/L,sensitivity 0.886,specificity 0.725;HDL:AUC 0.864,cut-off 0.98mmol/L,sensitivity 0.800,specificity 0.829.Conclusions:1.The pathogenic bacteria of elderly patients who have community-acquired pneumonia with type 2 diabetes mellitus are gram-negative bacilli.2.Compared with the good prognostic group,the elderly community-acquired pneumonia patients with type 2 diabetes mellitus in the poor prognostic group had more diabetes courses > 10 years,the worse control of weight,blood sugar and lipids,and the higher PCT.3.The course of diabetes mellitus,Hb A1 c and LDL are the risk factors for the community-acquired pneumonia patients with type 2 diabetes mellitus in elderly,yet the HDL is protective factor.3.When the results of laboratory examinations such as Hb A1c>8.75%,LDL >2.53mmol/L,HDL <0.98mmol/L,the prognosis situation of the patients may become worse. |
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