Clinical characteristics and pathogen distribution of patients with community-acquired pneumonia and type 2 diabetes mellitus_West China Medical Journal

Authors：

XIE Li ^1,2 , WANG Xiaochuan ³ , WANG Hanchao ^3,4 , LU Yi ³ , LI Ya ³ , WANG Haixin ³ , CHEN Ziqiang ³ ,  ZHU Tao ³ ,  ZHAO Chuan ²

1. Clinical Medical College of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
2. Department of Infectious Diseases, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;
3. Department of Respiratory Medicine and Critical Care Medicine, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;
4. GK Health and Medical Big Data Research Center of Suining, Suining, Sichuan 629000, P. R. China;

Corresponding author：

ZHU Tao, Email: zhutao063020@163.com; ZHAO Chuan, Email: 18008258941@163.com

Keywords：

Community-acquired pneumonia; type 2 diabetes mellitus; fungal infections; platelet; erythrocyte sedimentation rate

DOI：

10.7507/1002-0179.202409262

Video：

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Objective To investigate the clinical characteristics and pathogen distribution of community-acquired pneumonia (CAP) combined with type 2 diabetes mellitus (T2DM), based on bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing (mNGS) test. Methods In this cross-sectional study, CAP patients with BALF mNGS test were screened from April 2023 to April 2024. The patients were divided into a single CAP group (CAP group) and a CAP combine with T2DM group (CAP+T2DM group). The data of demographics, underlying diseases, complications, and laboratory tests including blood routine, inflammatory parameters, liver and renal functions, random blood glucose (RGB), hemoglobin A1C (HbA1c), and BALF mNGS tests were collected and compared between the two groups. Results Ultimately, 86 patients were included, with 45 in the CAP group and 41 in the CAP+T2DM group. Compared with the CAP group, the CAP+T2DM group had higher platelet count [(272.44±128.57)×10⁹/L vs. (215.00±100.06)×10⁹/L], erythrocyte sedimentation rate [(75.63±35.19) vs. (59.69±34.47) mm/h], RGB [10.8 (9.1, 13.5) vs. 6.5 (5.8, 7.8) mmol/L], HbA1c [8.2% (7.3%, 8.5%) vs. 5.7% (5.5%, 6.1%)], and fungi infection rate (65.9% vs. 40.0%), and the differences were statistically significant between the two groups (P<0.05). Conclusion CAP patients with T2DM have increased levels of platelet and erythrocyte sedimentation rate, and are at higher risk for fungi infection, which potentially leads to worse outcome.

1.	Liu YN, Zhang YF, Xu Q, et al. Infection and co-infection patterns of community-acquired pneumonia in patients of different ages in China from 2009 to 2020: a national surveillance study. Lancet Microbe, 2023, 4(5): e330-e339.
2.	Tsoumani E, Carter JA, Salomonsson S, et al. Clinical, economic, and humanistic burden of community acquired pneumonia in Europe: a systematic literature review. Expert Rev Vaccines, 2023, 22(1): 876-884.
3.	Mehta PB, Gosmanov AR. Inpatient glycemic control and community-acquired pneumonia outcomes in the pre-COVID-19 era: reviewing the evidence to pave the road for future studies. BMJ Open Diabetes Res Care, 2022, 10(4): e003011.
4.	Lepper PM, Bals R, Jüni P, et al. Blood glucose, diabetes and metabolic control in patients with community-acquired pneumonia. Diabetologia, 2020, 63(11): 2488-2490.
5.	中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版). 中华结核和呼吸杂志, 2016, 39(4): 253-279.
6.	Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clini Infect Dis, 2007, 44(Suppl 2): S27-S72.
7.	Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med, 1998, 15(7): 539-553.
8.	Xie G, Zhao B, Wang X, et al. Exploring the clinical utility of metagenomic next-generation sequencing in the diagnosis of pulmonary infection. Infect Dis Ther, 2021, 10(3): 1419-1435.
9.	GBD 2016 Lower Respiratory Infections Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis, 2018, 18(11): 1191-1210.
10.	Aldás I, Menéndez R, Méndez R, et al. Early and late cardiovascular events in patients hospitalized for community-acquired pneumonia. Arch Bronconeumol (Engl Ed), 2020, 56(9): 551-558.
11.	Anderson R, Feldman C. The global burden of community-acquired pneumonia in adults, encompassing invasive pneumococcal disease and the prevalence of its associated cardiovascular events, with a focus on pneumolysin and macrolide antibiotics in pathogenesis and therapy. Int J Mol Sci, 2023, 24(13): 11038.
12.	Huang J, Jiang E, Yang D, et al. Metagenomic next-generation sequencing versus traditional pathogen detection in the diagnosis of peripheral pulmonary infectious lesions. Infect Drug Resist, 2020, 13: 567-576.
13.	Gu W, Miller S, Chiu CY. Clinical metagenomic next-generation sequencing for pathogen detection. Annu Rev Pathol, 2019, 14: 319-338.
14.	Miao Q, Ma Y, Wang Q, et al. Microbiological diagnostic performance of metagenomic next-generation sequencing when applied to clinical practice. Clin Infect Dis, 2018, 67(Suppl_2): S231-S240.231-240.
15.	Abu-Ashour W, Twells L, Valcour J, et al. The association between diabetes mellitus and incident infections: a systematic review and meta-analysis of observational studies. BMJ Open Diabetes Res Care, 2017, 5(1): e000336.
16.	Joshi N, Caputo GM, Weitekamp MR, et al. Infections in patients with diabetes mellitus. N Engl J Med, 1999, 341(25): 1906-1912.
17.	Jensen AV, Baunbæk Egelund G, Bang Andersen S, et al. The glycemic gap and 90-day mortality in community-acquired pneumonia. a prospective cohort study. Ann Am Thorac Soc, 2019, 16(12): 1518-1526.
18.	Farrugia Y, Mangion J, Fava MC, et al. Inpatient hyperglycaemia, and impact on morbidity, mortality and re-hospitalisation rates. Clin Med (Lond), 2022, 22(4): 325-331.
19.	Barmanray RD, Cheuk N, Fourlanos S, et al. In-hospital hyperglycemia but not diabetes mellitus alone is associated with increased in-hospital mortality in community-acquired pneumonia (CAP): a systematic review and meta-analysis of observational studies prior to COVID-19. BMJ Open Diabetes Res Care, 2022, 10(4): e002880.
20.	Schuetz P, Friedli N, Grolimund E, et al. Effect of hyperglycaemia on inflammatory and stress responses and clinical outcome of pneumonia in non-critical-care inpatients: results from an observational cohort study. Diabetologia, 2014, 57(2): 275-284.
21.	Rafat Z, Hashemi SJ, Ashrafi K, et al. Fungal isolates of the respiratory tract in symptomatic patients hospitalized in pulmonary units: a mycological and molecular epidemiologic study. J Multidiscip Healthc, 2020, 13: 661-669.
22.	Rafat Z, Ramandi A, Khaki PA, et al. Fungal and bacterial co-infections of the respiratory tract among patients with COVID-19 hospitalized in intensive care units. Gene Rep, 2022, 27: 101588.
23.	Fang X, Mei Q, Fan X, et al. Diagnostic value of metagenomic next-generation sequencing for the detection of pathogens in bronchoalveolar lavage fluid in ventilator-associated pneumonia patients. Front Microbiol, 2020, 11: 599756.
24.	Lin S, Chen Y, Li H, et al. Diagnostic value and clinical use of metagenomic next-generation sequencing for invasive pulmonary aspergillosis. Am J Transl Res, 2024, 16(9): 4885-4893.
25.	Zhang S, Ou J, Tan Y, et al. Metagenomic next-generation sequencing for pulmonary infections diagnosis in patients with diabetes. BMC Pulm Med, 2023, 23(1): 142.
26.	宋章永. 侵袭性真菌感染与宿主免疫应答的评述. 西南医科大学学报, 2018, 41: 99-103.
27.	Anderson R, Feldman C. Review manuscript: mechanisms of platelet activation by the pneumococcus and the role of platelets in community-acquired pneumonia. J Infect, 2017, 75(6): 473-485.
28.	Aliberti S, Amir A, Peyrani P, et al. Incidence, etiology, timing, and risk factors for clinical failure in hospitalized patients with community-acquired pneumonia. Chest, 2008, 134(5): 955-962.
29.	Mirsaeidi M, Peyrani P, Aliberti S, et al. Thrombocytopenia and thrombocytosis at time of hospitalization predict mortality in patients with community-acquired pneumonia. Chest, 2010, 137(2): 416-420.
30.	Prina E, Ferrer M, Ranzani OT, et al. Thrombocytosis is a marker of poor outcome in community-acquired pneumonia. Chest, 2013, 143(3): 767-775.
31.	Hwang JY, Kwon YJ, Choi WJ, et al. Platelet count and 8-year incidence of diabetes: the Korean Genome and Epidemiology Study. Diabetes Res Clin Pract, 2018, 143: 301-309.
32.	Yun EK, Seo IH, Lee HS, et al. Sex differences in the relationship between platelet count and type 2 diabetes risk in community-dwelling adults: longitudinal findings over 14 years. Diabetes Metab Res Rev, 2023, 39(6): e3641.
33.	Lin Z, Vasudevan A, Tambyah PA. Use of erythrocyte sedimentation rate and C-reactive protein to predict osteomyelitis recurrence. J Orthop Surg (Hong Kong), 2016, 24(1): 77-83.
34.	Guo S, Wang M, Yu Y, et al. The association of erythrocyte sedimentation rate, high-sensitivity C-reactive protein and diabetic kidney disease in patients with type 2 diabetes. BMC Endocr Disord, 2020, 20(1): 103.
35.	Kornum JB, Thomsen RW, Riis A, et al. Diabetes, glycemic control, and risk of hospitalization with pneumonia: a population-based case-control study. Diabetes Care, 2008, 31(8): 1541-1545.

1. Liu YN, Zhang YF, Xu Q, et al. Infection and co-infection patterns of community-acquired pneumonia in patients of different ages in China from 2009 to 2020: a national surveillance study. Lancet Microbe, 2023, 4(5): e330-e339.
2. Tsoumani E, Carter JA, Salomonsson S, et al. Clinical, economic, and humanistic burden of community acquired pneumonia in Europe: a systematic literature review. Expert Rev Vaccines, 2023, 22(1): 876-884.
3. Mehta PB, Gosmanov AR. Inpatient glycemic control and community-acquired pneumonia outcomes in the pre-COVID-19 era: reviewing the evidence to pave the road for future studies. BMJ Open Diabetes Res Care, 2022, 10(4): e003011.
4. Lepper PM, Bals R, Jüni P, et al. Blood glucose, diabetes and metabolic control in patients with community-acquired pneumonia. Diabetologia, 2020, 63(11): 2488-2490.
5. 中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版). 中华结核和呼吸杂志, 2016, 39(4): 253-279.
6. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clini Infect Dis, 2007, 44(Suppl 2): S27-S72.
7. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med, 1998, 15(7): 539-553.
8. Xie G, Zhao B, Wang X, et al. Exploring the clinical utility of metagenomic next-generation sequencing in the diagnosis of pulmonary infection. Infect Dis Ther, 2021, 10(3): 1419-1435.
9. GBD 2016 Lower Respiratory Infections Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis, 2018, 18(11): 1191-1210.
10. Aldás I, Menéndez R, Méndez R, et al. Early and late cardiovascular events in patients hospitalized for community-acquired pneumonia. Arch Bronconeumol (Engl Ed), 2020, 56(9): 551-558.
11. Anderson R, Feldman C. The global burden of community-acquired pneumonia in adults, encompassing invasive pneumococcal disease and the prevalence of its associated cardiovascular events, with a focus on pneumolysin and macrolide antibiotics in pathogenesis and therapy. Int J Mol Sci, 2023, 24(13): 11038.
12. Huang J, Jiang E, Yang D, et al. Metagenomic next-generation sequencing versus traditional pathogen detection in the diagnosis of peripheral pulmonary infectious lesions. Infect Drug Resist, 2020, 13: 567-576.
13. Gu W, Miller S, Chiu CY. Clinical metagenomic next-generation sequencing for pathogen detection. Annu Rev Pathol, 2019, 14: 319-338.
14. Miao Q, Ma Y, Wang Q, et al. Microbiological diagnostic performance of metagenomic next-generation sequencing when applied to clinical practice. Clin Infect Dis, 2018, 67(Suppl_2): S231-S240.231-240.
15. Abu-Ashour W, Twells L, Valcour J, et al. The association between diabetes mellitus and incident infections: a systematic review and meta-analysis of observational studies. BMJ Open Diabetes Res Care, 2017, 5(1): e000336.
16. Joshi N, Caputo GM, Weitekamp MR, et al. Infections in patients with diabetes mellitus. N Engl J Med, 1999, 341(25): 1906-1912.
17. Jensen AV, Baunbæk Egelund G, Bang Andersen S, et al. The glycemic gap and 90-day mortality in community-acquired pneumonia. a prospective cohort study. Ann Am Thorac Soc, 2019, 16(12): 1518-1526.
18. Farrugia Y, Mangion J, Fava MC, et al. Inpatient hyperglycaemia, and impact on morbidity, mortality and re-hospitalisation rates. Clin Med (Lond), 2022, 22(4): 325-331.
19. Barmanray RD, Cheuk N, Fourlanos S, et al. In-hospital hyperglycemia but not diabetes mellitus alone is associated with increased in-hospital mortality in community-acquired pneumonia (CAP): a systematic review and meta-analysis of observational studies prior to COVID-19. BMJ Open Diabetes Res Care, 2022, 10(4): e002880.
20. Schuetz P, Friedli N, Grolimund E, et al. Effect of hyperglycaemia on inflammatory and stress responses and clinical outcome of pneumonia in non-critical-care inpatients: results from an observational cohort study. Diabetologia, 2014, 57(2): 275-284.
21. Rafat Z, Hashemi SJ, Ashrafi K, et al. Fungal isolates of the respiratory tract in symptomatic patients hospitalized in pulmonary units: a mycological and molecular epidemiologic study. J Multidiscip Healthc, 2020, 13: 661-669.
22. Rafat Z, Ramandi A, Khaki PA, et al. Fungal and bacterial co-infections of the respiratory tract among patients with COVID-19 hospitalized in intensive care units. Gene Rep, 2022, 27: 101588.
23. Fang X, Mei Q, Fan X, et al. Diagnostic value of metagenomic next-generation sequencing for the detection of pathogens in bronchoalveolar lavage fluid in ventilator-associated pneumonia patients. Front Microbiol, 2020, 11: 599756.
24. Lin S, Chen Y, Li H, et al. Diagnostic value and clinical use of metagenomic next-generation sequencing for invasive pulmonary aspergillosis. Am J Transl Res, 2024, 16(9): 4885-4893.
25. Zhang S, Ou J, Tan Y, et al. Metagenomic next-generation sequencing for pulmonary infections diagnosis in patients with diabetes. BMC Pulm Med, 2023, 23(1): 142.
26. 宋章永. 侵袭性真菌感染与宿主免疫应答的评述. 西南医科大学学报, 2018, 41: 99-103.
27. Anderson R, Feldman C. Review manuscript: mechanisms of platelet activation by the pneumococcus and the role of platelets in community-acquired pneumonia. J Infect, 2017, 75(6): 473-485.
28. Aliberti S, Amir A, Peyrani P, et al. Incidence, etiology, timing, and risk factors for clinical failure in hospitalized patients with community-acquired pneumonia. Chest, 2008, 134(5): 955-962.
29. Mirsaeidi M, Peyrani P, Aliberti S, et al. Thrombocytopenia and thrombocytosis at time of hospitalization predict mortality in patients with community-acquired pneumonia. Chest, 2010, 137(2): 416-420.
30. Prina E, Ferrer M, Ranzani OT, et al. Thrombocytosis is a marker of poor outcome in community-acquired pneumonia. Chest, 2013, 143(3): 767-775.
31. Hwang JY, Kwon YJ, Choi WJ, et al. Platelet count and 8-year incidence of diabetes: the Korean Genome and Epidemiology Study. Diabetes Res Clin Pract, 2018, 143: 301-309.
32. Yun EK, Seo IH, Lee HS, et al. Sex differences in the relationship between platelet count and type 2 diabetes risk in community-dwelling adults: longitudinal findings over 14 years. Diabetes Metab Res Rev, 2023, 39(6): e3641.
33. Lin Z, Vasudevan A, Tambyah PA. Use of erythrocyte sedimentation rate and C-reactive protein to predict osteomyelitis recurrence. J Orthop Surg (Hong Kong), 2016, 24(1): 77-83.
34. Guo S, Wang M, Yu Y, et al. The association of erythrocyte sedimentation rate, high-sensitivity C-reactive protein and diabetic kidney disease in patients with type 2 diabetes. BMC Endocr Disord, 2020, 20(1): 103.
35. Kornum JB, Thomsen RW, Riis A, et al. Diabetes, glycemic control, and risk of hospitalization with pneumonia: a population-based case-control study. Diabetes Care, 2008, 31(8): 1541-1545.

West China Medical Journal

Latest ArticlesClinical characteristics and pathogen distribution of patients with community-acquired pneumonia and type 2 diabetes mellitus

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