Clinical Outcomes of Community-Acquired Pneumonia in Patients with Diabetes Mellitus

Background: Studies have found admission hyperglycemia as a predictor of poor outcomes in Community acquired Pneumonia (CAP), whereas others have not. The objective of this study was to evaluate the impact of diabetes mellitus (DM) on mortality as well as Length of stay (LOS) and Time to clinical stability (TCS) of hospitalized patients with CAP. Materials and Methods: Adult patients hospitalized with CAP enrolled at Community-Acquired Pneumonia Organization (CAPO) database with DM were categorized as admission blood glucose ≥ 250 mg/dL (diabetes mellitus blood sugar (BG) \u3e 250) and admission blood glucose ≤ 250 mg/dL (DM BG ≤ 250). CAP outcomes included: all-cause in-hospital mortality, all-cause 28-day mortality, length of stay (LOS) and time to clinical stability (TCS). Results: From a total of 7,303 patients with CAP, 294 (17.7%) had DM; out of whom 960 (13.1%) patients had BG ≤ 250 mg/dL, and 334 (4.6%) patients had BG \u3e 250 mg/dL. The in-hospital mortality was 9.3% for controls, 9.9% for the DM BG ≤ 250 mg/dL group and 13.4% for DM BG \u3e 250 mg/dL group (p = 0.04). Patients with DM BG \u3e 250 mg/dL compared to the control group had a higher risk of in-hospital mortality (Hazard ratio (RR) = 1.32, 95% CI: 1.02-1.72, p = 0.034) and 28-day mortality (RR = 1.31, 95% CI: 1.01-1.71, p = 0.048). Patients in the DM BG ≤ 250 mg/dL group compared to the control group did not have a greater risk for in-hospital mortality (RR = 1.23, 95% CI: 0.16-8.09, p = 0.237), 28-day mortality (RR = 1.09, 95% CI: 0.90-1.32, p = 0.398), LOS (HR = 0.93, 95% CI: 0.85-1.02, p = 0.130), or TCS (HR = 0.95, 95% CI: 0.87-1.05, p = 0.320). Conclusions: DM patients with BG \u3e 250 mg/dL were associated with increased in-hospital mortality and 28-day mortality. Further studies are needed to link the role of hyperglycemia to CAP outcome