Diabetes e hiperglicemia: fatores de prognóstico na pneumonia adquirida na comunidade

Fernandes, V; Ramalho, J; Santos, MJ; Oliveira, N; Lopes-Pereira, M

http://hdl.handle.net/10400.23/910

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Background: Community acquired pneumonia (CAP) is a common condition and a major cause of morbidity. Diabetes mellitus (DM) increases the risk and complications of infectious diseases. However, the role of DM and glycemia at the time of presentation as prognostic factors in patients with CAP remains to be clarified. Aims: To evaluate the relationship between DM/glycemia at the time of presentation and complications, length of stay and mortality in patients with CAP, and the relationship between glycemic control and complications in patients with diabetes.Methods: Observational, analytical and retrospective study of adults admitted to our hospital between October/2011 and March/2012, with CAP. Electronic clinical data were analyzed and telephone calls were done to assess mortality at 30 and 90 days. The chi-square test, Mann-Whitney and Kruskal-Wallis tests, and logistic regression were used. Results: Of the 440 included patients, 51.1% were women, 83.1% elderly and 29.3% had diagnosis of DM. Of these, 48.8% had HbA1c measured (median 6.8%, IQR: 6.3-7.8%). The median glucose was 134 mg/dL (IQR: 111-176 mg/dL). Patients with DM were older (p = 0.002), had higher severity of pneumonia (p = 0.025), more complications (p = 0.001) and longer hospital stay (p = 0.001). DM proved to be a predictor of complications (p = 0.008). No association between DM and mortality was found, nor between HbA1c levels and complications, length of stay and mortality. Higher glucose levels at admission were associated with longer hospital stay (p = 0.016) and patients with hyperglycemia on admission had more complications (no statistically significant). However, no association between glucose levels on admission and mortality was found. Conclusion: DM and hyperglycemia on admission are associated with adverse outcome in CAP. Both are associated with longer hospital stay and DM predicts complications from CAP.