Study On The Prognostic Value Of Different Severity Scoring Systems For Type 2 Diabetes Mellitus Patients With Community-acquired Pneumonia

Objectives: Diabetes mellitus is a chronic metabolic disease threatening human health,with type 2 diabetes mellitus(T2DM)as the main type.Because the immune function of patients with diabetes mellitus is impaired,they are prone to develop community acquired pneumonia(CAP),and their incidence rate and mortality are higher than those of patients without diabetes mellitus.Although there are many scoring systems for evaluating the severity of the disease in the world,there are no clinical studies on which scoring systems are more valuable for evaluating the prognosis of T2DM patients with CAP.This study intends to analyze the general situation and prognosis of T2DM patients with CAP from multi-center,evaluate the risk of death in hospital by using different quantifiable scoring systems available,and screen the best scoring system that can be used for clinical evaluation of the prognosis of T2DM patients with CAP..Methods: From January 2009 to December 2019,we retrospectively analyzed clinical data of T2DM patients with CAP who were hospitalized in 6 hospitals from Shenyang.Patients’ general data,vital signs,laboratory tests,and imaging studies were statistically analyzed.The scores of PSI,CURB-65,SMART-COP,SOFA,qSOFA,APACHE Ⅱ,SAPS Ⅱ,A-DROP and MEWS of each patients were calculated according to the data.The patients were divided into two groups according to their status at discharge.We draw the receiver operating characteristic(ROC)curve.The scores were divided according to the optimal cut-off value,and the mortality of each segment was calculated.Results: A total of 226 T2DM patients with CAP were enrolled according to the inclusion and exclusion criteria,including 159 males and 67 females.There were 99 patients in the death group and 127 patients in the survival group.The results of ROC curve showed that SAPS Ⅱ,SOFA and PSI were the top three in predicting the risk of death in T2DM patients with CAP.The area under the curve(AUC)of SAPS Ⅱ was0.853,the best cut-off value was 40.5,the sensitivity was 74.7%,and the specificity was 80.3%.The positive predictive value was 74.7% and the negative predictive value was 80.3%.When SAPS Ⅱ score ≥40,the mortality rate was as high as 63.5%.The AUC of SOFA was 0.846,the best cut-off value was 3.5,the sensitivity was89.9%,the specificity was 66.1%,the positive predictive value was 67.4%,and the negative predictive value was 89.4%.When the SOFA score was between 6-8,the mortality rate could reach 68.5%.The AUC of PSI was 0.833,the best cut-off value was 126.5,the sensitivity was 76.8%,the specificity was 78%,the positive predictive value was 73.1%,and the negative predictive value was 81.2%.When PSI score >130(grade Ⅴ),the mortality rate was as high as 72.7%.Conclusions: The three scoring systems of SAPS Ⅱ,SOFA and PSI have good predictive value for the prognosis of T2DM patients with CAP,and can be used to evaluate the risk of death in hospital.