The Relationship Between Diabetes and Pneumonia

doi:10.21203/rs.3.rs-5194658/v1

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The Relationship Between Diabetes and Pneumonia

https://doi.org/10.21203/rs.3.rs-5194658/v1

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This study was conducted to determine the relationship between the severity of pneumonia and its adverse outcomes associated with the presence of diabetes. It included 213 patients admitted to the chest department with pneumonia and diabetes. The retrospective methodology was adopted by conducting a statistical and semantic study, where information was collected from patient records, and diabetes characteristics such as the duration of the disease and complications associated with the presence of the disease were determined. In addition, adverse outcomes of pneumonia such as the need for admission to the intensive care unit according to the severity of the disease measured by the CURB-65 scale, the need for oxygen, or the occurrence of death were determined. The results showed that diabetic patients with pneumonia are more vulnerable and at risk in the context of pneumonia in terms of the need for admission to the intensive care unit, oxygen therapy, the need for invasive mechanical ventilation, and the severity of pneumonia, in addition to an increased mortality rate. The study also found a significant relationship between blood sugar values at admission and the occurrence of death in diabetic patients with pneumonia.

General Practice

Diabetes

Pneumonia

CURB-65 scale

intensive care unit

Oxygenation process

invasive mechanical ventilation

In the realm of contemporary medicine, the number of people dealing with health issues is rising, particularly as chronic illnesses like diabetes and pneumonia become more common. Diabetes is a chronic illness marked by elevated blood sugar levels [1]. It is caused by abnormalities in the body's system for producing or using insulin, individuals' health is directly impacted by this imbalance [2]. Apart from its impact on essential organs, research indicates that individuals with diabetes have an increased vulnerability to other immune system problems, such as pneumonia [3].

One of the most common illnesses that impairs the respiratory system's function is pneumonia. Pneumonia is a big problem, especially among people suffering from chronic illnesses such as diabetes [4]. Studies indicate that diabetes is associated with an increased chance of pneumonia cases getting worse, as well as a higher likelihood of more serious consequences in general for individuals with diabetes [5].

Medical history demonstrates that a robust correlation between diabetes and elevated rates of pneumonia has been discovered over time by researchers [6]. According to studies, those with poorly managed diabetes or high blood sugar are more likely to have pneumonia and may experience more serious side effects [7]. Diabetes symptoms may intensify as the condition develops and becomes more complex, which may make recovery and treatment more challenging [8].

However, why does this occur? What effects does diabetes have on lung function and the immune system? Researchers have found that there is more to the association between diabetes and pneumonia than just a straightforward cause-and-effect relationship [9]. These include immune response changes and physiological alterations that may increase a patient's susceptibility to infections that are more difficult to treat [10].

We hope to clarify this intricate link by examining related literature, evaluating clinical data that is currently accessible, and investigating the variables that affect this occurrence. Additionally, this study aims to evaluate the relationship between diabetes and the severity of pneumonia in order to improve the quality of life of patients through better control of diabetes.

This study fits into the larger picture of the continued need for a deeper comprehension of this relationship, which will help medical professionals create efficient plans for treating and preventing pneumonia in diabetic patients, as well as use the knowledge they acquire to improve patient outcomes.

This study included 213 patients admitted to the chest department with pneumonia and diabetes. Patients with type 2 diabetes were screened, information was collected from patient records, and diabetes characteristics such as duration of illness and complications associated with the presence of the disease were determined. In addition, adverse outcomes of pneumonia such as the need for admission to the intensive care unit according to the severity of the disease measured by the CURB-65 scale, the need for oxygenation, or the occurrence of death were determined. To find the association between the severity of pneumonia and adverse outcomes, and the presence of diabetes.

This study relied on the retrospective methodology by conducting a statistical and semantic study, where information was collected from patient records in the chest internal department of the hospital, after obtaining ethical approval. An automated electronic questionnaire was created and archived electronically, and exclusion criteria were determined by deleting the participation of patients whose records data did not complete all the information required for the study.

The statistical processing of the data obtained was carried out using the SPSS.v26 program in order to analyze this data. The statistical processing included descriptive statistics, which consists of finding the relative frequency distributions of the study variables within the categories. And indicative statistics through displaying and interpreting the results and inferring them in order to reach the study objective, in addition to the Chi-square test, to determine the possibility of a relationship between two descriptive variables. The variance was then analyzed to test the differences between the means of two or more groups, in order to determine the possibility of the existence of statistically significant differences between the means of the different groups, and this helps in identifying whether the independent variable has an effect on the dependent variable.

The estimation of the differences and statistical relationships was based on a statistical significance level of 0.05, which is the level adopted in the reference studies, and thus the statistical evaluation can be given through the P-value. If the statistical significance value P-Value is greater than 0.05, this means that there are no fundamental differences in the evaluation of the differences and relationships. If the value of statistical significance is less than 0.05, this indicates the presence of statistically significant differences in the assessment of differences and relationships, as (P < 0.001) indicates a high level of significance.

3.1. Descriptive analysis of study variables

The demographic data of the 213 patients with pneumonia showed that the number of males was (54.9%) and the number of females was (45.1%). The age group ranged between 65 years and above with a percentage of (52.1%), and the percentage of smokers was (65.3%), while the number of alcoholics was less than (7.5%). The majority of the participants were from Damascus Governorate with a percentage of (49.8%) or Rural Damascus with a percentage of (42.3%).

The number of people with type 1 diabetes was 5.6%, and type 2 diabetes was 32.9%. As for those with type 2 diabetes, they were distributed between 34.3% who had been infected for 20–30 years, and 31.4% for 15–20 years. The results showed that the most common diabetic complications were kidney failure (18.3%) and heart failure (13.1%).

Regarding the most common pulmonary manifestations, the percentage of productive cough (84.5%) and respiratory distress (93.9%) were recorded.

The results of pneumonia showed that more than half of the sample (53.5%) were admitted to the department, while 46.5% required admission to the intensive care unit. 68.1% of the participants required oxygen, and 31% of them showed pulmonary complications.

The mortality rate in the sample was 30.5%. Looking at the CURB-65 index, it was found that 38.5% of the participants had a score of 3 or more, indicating the severity of their condition.

3.2. Semantic analysis of study variables

3.2.1. The relationship between diabetes and the average length of hospital stay for patients with pneumonia

The results indicated that there were no statistically significant differences in the duration of hospital stay between patients with pneumonia with type 2 diabetes and those without it from the same patient population, as the ratio (P < 0.05) was not achieved.

3.2.2. The relationship between the type of hospital admission and diabetes in patients with pneumonia

The study of the relationship between type 2 diabetes and type of admission in patients with pneumonia showed that most patients with type 2 diabetes (approximately 69%) were admitted to the intensive care unit (ICU). In contrast, most patients without the disease (approximately 64%) were admitted to the thoracic department, with a statistically significant difference (P < 0.05). In addition, the odds ratio (OR) calculation showed that patients with type 2 diabetes were four times more likely to be admitted to the ICU.

3.3. The relationship between treatment method and diabetes in patients with pneumonia

need for oxygen

When studying the relationship between type 2 diabetes and the need for oxygen versus the need for medications in patients with pneumonia, the results showed that the management of pneumonia in the majority of patients with type 2 diabetes required the need for oxygen at a rate of 90%, in contrast to approximately 57% of patients without type 2 diabetes, with a statistically significant difference at a high level (P < 0.001). In addition, the calculation of the odds ratio (OR) showed that the probability of requiring oxygen in pneumonia patients with type 2 diabetes was approximately seven times higher than in patients without type 2 diabetes.

Difference between oxygenation methods

In a study of the relationship between type 2 diabetes and the method of oxygenation in patients with pneumonia who required oxygenation (N = 146), it was found that more patients with type 2 diabetes required mechanical ventilation (46%) and non-invasive ventilation (NIV) (approximately 32%), compared with those without type 2 diabetes, most of whom required non-invasive methods, as 47% of them were placed on a cannula or mask, and approximately 30% on non-invasive ventilation, with a statistically significant difference (P < 0.01).

According to the previous results, the difference between patients with pneumonia who need oxygen therapy in diabetic patients compared to non-diabetic patients in terms of the need for mechanical ventilation was studied. The results showed that when calculating the odds ratio (Odds Ratio), the probability of needing mechanical ventilation is closer to three times in patients with type 2 diabetes, as shown in (Figure.1).

Figure (1): The difference between diabetic and non-diabetic pneumonia patients in terms of the need for mechanical ventilation

3.4. The relationship between mortality and type 2 diabetes in patients with pneumonia

The results showed that slightly less than half of diabetic patients died from pneumonia, compared to only 24% of non-diabetic patients, with a statistically significant difference (P < 0.05). In addition, when calculating the odds ratio (OR), it was found that the probability of death from pneumonia was two and a half times greater among type 2 diabetic patients compared to non-diabetic patients, as shown in (Figure.2).

Figure (2): Difference in mortality between diabetic and non-diabetic pneumonia patients

3.5. Relationship between pneumonia severity by CURB-65 and diabetes in pneumonia patients

CURB-65 score thresholds were used as an indicator of the severity of pneumonia in patients. The results showed that the proportion of patients with type 2 diabetes increased with increasing severity of pneumonia. Whereas, most patients with a severity of less than (1) on the CURB-65 scale were not diabetic, while half of the patients with a severity of (3) or higher were type 2 diabetic patients. These differences were statistically significant at a high level of significance (P < 0.001).

3.6. Difference between diabetic and non-diabetic pneumonia patients in terms of mortality taking into account the severity of pneumonia

The results indicated that there were statistically significant differences (P < 0.001) in mortality rates between diabetic and non-diabetic pneumonia patients, taking into account the severity of pneumonia. In diabetic patients, the risk of death increased significantly with increasing pneumonia severity. The mortality rate was 6.5% for patients with severity between (0–1), 9.7% for patients with severity (2), and 83.9% for patients with severity (3) or more. On the other hand, it was noted that most non-diabetic pneumonia patients (63.3%) were in the less severe category ranging from (0–1), while this rate decreased to 21.1% and 15.6% in the more severe categories, respectively.

3.7. CURB-65 index with hospital stay duration

The relationship between pneumonia severity, as reflected by the CURB-65 index, and hospital length of stay was evaluated in diabetic and non-diabetic patients. The results showed that the mean hospital length of stay for diabetic patients was 4.6 ± 3.4 days for the group with a score of (0–1), 4.9 ± 2.5 days for the group with a score of (2), and 5.7 ± 5.7 days for the group with a score of (≥ 3). In contrast, the mean hospital length of stay for non-diabetic patients was 4.9 ± 4.1 days for the group with a score of (0–1), 6.1 ± 5.4 days for the group with a score of (2), and 5.3 ± 4.6 days for the group with a score of (≤ 3).

Analysis of variance showed that there were no statistically significant differences between diabetic and non-diabetic patients in the mean length of stay across the different levels of pneumonia severity. These results suggest that type 2 diabetes is not associated with an increased length of stay for patients with pneumonia, regardless of the severity of pneumonia.

3.8. The relationship between random sugar value and the occurrence of death

The results showed that the mean random blood glucose level was 363 ± 172 mg/dL in diabetic patients who died, while it was 241 ± 81 mg/dL in diabetic patients who did not die. In contrast, the mean random blood glucose level was 111 ± 54 mg/dL in non-diabetic patients who died, while it was 133 ± 58 mg/dL in non-diabetic patients who did not die.

ANOVA showed that these differences were statistically significant (F = 15.6, P < 0.001). These results indicate that higher random blood glucose levels are associated with a significantly increased risk of death in diabetic patients with pneumonia compared to non-diabetic patients from the same population.

This study aimed to evaluate the relationship between diabetes and the severity of pneumonia. There are relatively few reference studies and reports in the medical literature regarding the incidence of diabetes in patients with pneumonia. The results of this study showed that approximately 33% of hospitalized pneumonia patients had type 2 diabetes. These results are consistent with the results of a large hospital population study in 2015 [11] which was 28% of hospitalized community-acquired pneumonia patients, and which indicated an increase in the rate over time.

In type 1 diabetes, only 5% of patients with pneumonia had pneumonia. One study suggested that the mechanisms that increase the risk and severity of pneumonia in diabetes are related to the effects of hyperglycemia, including impaired neutrophil degranulation, complement activation, and phagocytosis [12].

This study evaluated the increased severity of pneumonia in diabetic versus non-diabetic patients through several factors. First, the ICU admission rate was higher in diabetic patients than in non-diabetic patients (69% vs. 36%), with a statistically significant difference (P < 0.05). When calculating the odds ratio, the likelihood of ICU admission in diabetic pneumonia patients was approximately four times greater than in non-diabetic patients. This is consistent with a 2019 Egyptian study that compared diabetic and non-diabetic pneumonia patients in terms of ICU admission, with similar results (60% vs. 30%) with a statistically significant difference [13].

In addition, the results showed no statistically significant differences in the length of hospital stay between the diabetic and non-diabetic pneumonia patient's groups (average days for diabetic patients 5.34 versus 5.33 for non-diabetic patients). This result is consistent with the results of a Spanish study in 2020 [14], where there were no significant differences between the two groups of patients, as it was (9.78%) for diabetic patients versus (9.77%) for non-diabetic patients.

Second, the need for oxygen, as it was found that the rate of need for oxygen therapy was significantly higher in diabetic patients with pneumonia (90% vs 57%), with a statistically significant difference (P < 0.001), and the odds ratio was approximately 7 times, meaning that the need for oxygen therapy was seven times greater in diabetic patients with pneumonia. This result is consistent with the Egyptian study in 2019 [15], which reported a statistically significant difference in the need for oxygen (70% vs. 30%), which is the only study that reported this factor.

In addition, it was found that there were statistically significant differences in the methods of oxygen therapy, whether invasive or non-invasive, among patients with pneumonia, as most patients with type 2 diabetes needed mechanical ventilation (46%), and non-invasive ventilation (NIV) (approximately 32%), compared to those without type 2 diabetes, most of whom needed non-invasive methods, with the important result that the need for invasive ventilation was three times greater (OR = 3), in diabetic patients with pneumonia compared to non-diabetic patients. While the results of the Egyptian study in 2019 [16] reported no statistically significant differences between the two groups of patients in terms of the need for mechanical ventilation.

Third, the results of the CURB-65 scale for assessing differences in the severity of pneumonia showed that diabetic patients with pneumonia achieved higher rates on the CURB-65 scale compared to non-diabetic patients with statistically significant differences (P < 0.001).

These results are consistent with many studies that used different scales expressing the severity of pneumonia in patients, including (CURB-65), and all of them mention an increase in the severity of the disease in diabetic patients compared to non-diabetic patients with statistically significant differences [17].

As for the mortality rate, the results showed statistically significant differences (44% vs. 24%), with the probability of death being at least two and a half times greater in diabetic patients with pneumonia compared to non-diabetic patients. These results are also consistent with the study in Spain [18].

This study provided important results regarding the impact of diabetes on the outcomes of pneumonia in patients, and indicated that diabetic patients with pneumonia are more likely and more dangerous in the context of pneumonia in terms of the need for admission to the intensive care unit, the need for oxygen therapy, the need for invasive mechanical ventilation, the severity of pneumonia, in addition to the increased mortality rate. The study also found a significant relationship between blood sugar values upon admission and the occurrence of death in diabetic patients with pneumonia. Therefore, these results contribute to taking measures related to conducting periodic examinations for early detection of diabetes, which increases the symptoms and risk of pneumonia patients, in order to work on controlling it early with continuous treatment under supervision. In addition to increasing awareness about the risk factors associated with diabetes such as obesity and smoking and the importance of implementing strategies to modify lifestyle.

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The authors declare no competing interests.

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The Relationship Between Diabetes and Pneumonia

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Abstract

Figures

1. Introduction

2. Materials and Methods

3. Results

3.1. Descriptive analysis of study variables

3.2. Semantic analysis of study variables

3.2.1. The relationship between diabetes and the average length of hospital stay for patients with pneumonia

3.2.2. The relationship between the type of hospital admission and diabetes in patients with pneumonia

3.3. The relationship between treatment method and diabetes in patients with pneumonia

3.4. The relationship between mortality and type 2 diabetes in patients with pneumonia

3.5. Relationship between pneumonia severity by CURB-65 and diabetes in pneumonia patients

3.7. CURB-65 index with hospital stay duration

3.8. The relationship between random sugar value and the occurrence of death

4. Discussion

5. Conclusion

References

Additional Declarations

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