Risk Factors Analysis And Prediction Models Establishment Of In-hospital Mortality Among Community-acquired Pneumonia Patients With Type 2 Diabetes Mellitus

Objective: The aim of the present study was to investigate the risk factors for in-hospital mortality among community-acquired pneumonia(CAP)patients with type 2 diabetes mellitus(T2DM),and establish a risk prediction model.Methods: Data from 1,360 adult patients with CAP and T2 DM hospitalized in two grade3 A hospitals(Shengjing Hospital of China Medical University and the First Affiliated Hospital of China Medical University)between 2009 and 2019 were collected through clinical data platform and electronic medical record system(EMRS)of hospitals.Data obtained included the vital signs on admission,the status of diabetes mellitus,diabetic complications,other underlying diseases,laboratory and imaging findings on admission,outcomes of treatment endpoints,etc.Then the study cohort were divided into 2 groups(death group and survival group)according to the patient’s treatment endpoints(death,or improvement and discharge).Statistical analysis including univariate and multivariate was conducted to investigate the risk factors affecting prognosis,and a clinical risk prediction model was established.Results:18 parameters between 2 groups(death group and survival group)were significant after segmentation,and they were pulse rate on admission,blood pressure on admission,whether the state of consciousness has changed from onset to admission,arterial blood p H,age,neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),initial fasting blood glucose,serum sodium,chest radiography on admission suggested multilobar infiltrate,and diabetic nephropathy,etc.However,the following nine parameters were independent predictors of mortality: neutrophil-lymphocyte ratio(NLR)≥4,pulse rate ≥125 bpm,change in state of consciousness,arterial blood p H≤7.35,age ≥65 years,serum sodium ≤130 mmol/L,initial fasting blood glucose ≥9mmol/L,multilobar infiltrate on admission,and diabetic nephropathy.Based on these findings,a risk prediction score was established,and bootstrap validation was performed.The result of validation showed that the risk prediction score was significantly superior to CURB-65 [confusion,urea >7 mmol/L,respiratory rate >30/min,low blood pressure(systolic <90 mm Hg or diastolic <60 mm Hg),age >65 years] and slightly superior than the pneumonia severity index(PSI).Conclusion: The influencing factors for in-hospital mortality among CAP patients with T2 DM included advanced age,male,increased pulse rate,blood pressure decreased,change in state of consciousness,high NLR,high PLR,lymphocyte of peripheral blood decreased,hyponatremia,acidosis,hypoxemia,fasting hyperglycemia,multilobar infiltrate and pleural effusion on admission,chronic renal insufficiency,diabetic nephropathy,and cerebrovascular disease.Furthermore the independent risk factors included age ≥65 years,change in state of consciousness,pulse rate ≥125 bpm,arterial blood p H ≤7.35,neutrophil-lymphocyte ratio(NLR)≥4,serum sodium ≤130 mmol/L,initial fasting blood glucose ≥9 mmol/L,diabetic nephropathy,and multilobar infiltrate on admission.These parameters should be recognized in clinical practice,with active interventions to improve the treatment success rate.The risk prediction score effectively differentiated the mortality risk of inpatients,thereby providing guidance on clinical decision-making.