Relación entre la diabetes mellitus y la mortalidad de la neumonía adquirida en la comunidad

  • Deisy Gabriela Cardozo Jiménez Hospital Nacional, Itauguá.
Palabras clave: diabetes mellitus, neumonía aguda de la comunidad, mortalidad

Resumen

Introducción: la neumonía adquirida en la comunidad (NAC) se asocia con una morbilidad y mortalidad considerables. La infección pulmonar lo hace por sí misma pero también por su asociación con la diabetes mellitus (DM), la que representa un papel importante en esos resultados.

Objetivos: determinar la influencia de la DM en el desenlace de la NAC.

Materiales y método: estudio de cohortes retrospectiva. Cohorte 1: varones y mujeres mayores de 16 años con DM y NAC ingresados al Hospital Nacional en los años 2013-2014. Cohorte 2: varones y mujeres mayores de 16 años portadores de NAC, sin DM, ingresados al Hospital Nacional en el mismo periodo.

Resultados: se incluyeron 32 sujetos en la cohorte 1 y 104 en la cohorte 2. Fallecieron 11 pacientes, de los cuales 3 (9%) corresponden a la cohorte 1 y 8 (7%) a cohorte 2 (RR 0,97 IC 95% 0,8-1,1 p 0,6). Se observó mayor estadía hospitalaria en pacientes con hiperglicemia al ingreso. Se encontró un Curb65 medio de 1,1±0,9 en altas vivos y 2,2±0,7 en pacientes que obitaron (p 0,0004).  

Conclusión: la DM no se asoció significativamente con mayor mortalidad ni mayor estancia hospitalaria en pacientes con NAC.

Citas

Rello J. Demographics, guidelines, and clinical experience in severe community-acquired pneumonia. Crit Care. 2008; 12 Suppl 6: S2.

Rudan I, O'Brien KL, Nair H, Liu L, Theodoratou E, Qazi S, et al. Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries. J Glob Health. 2013 Jun; 3(1): 010401.

Wunderink RG, Waterer GW. Community-acquired pneumonia: pathophysiology and host factors with focus on possible new approaches to management of lower respiratory tract infections. Infect Dis Clin North Am. 2004 Dec; 18(4): 743-59

Strieter RM, Belperio JA, Keane MP. Host innate defenses in the lung: the role of cytokines. Curr Opin Infect Dis. 2003 Jun; 16(3): 193-8.

Mason CM, Nelson S. Pulmonary host defenses and factors predisposing to lung infection. Clin Chest Med. 2005 Mar; 26(1): 11-7.

Levy ML, Le Jeune I, Woodhead MA, Macfarlaned JT, Lim WS. Primary care summary of the British Thoracic Society Guidelines for the management of community acquired pneumonia in adults: 2009 update. Endorsed by the Royal College of General Practitioners and the Primary Care Respiratory Society UK. Prim Care Respir J. 2010 Mar; 19(1): 21-7.

Arancibia MF, Vega-Briceño LE, Pizarro ME, Pulgar D, Holmgren N, Bertrand P, et al. Empyema and pleural effusion in children. Rev Chilena Infectol. 2007 Dec; 24(6): 454-61.

Alfageme I, Aspa J, Bello S, Blanquer J, Blanquer R, Borderías L, et al. Guidelines for the diagnosis and management of community-acquired pneumonia. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Arch Bronconeumol. 2005 May; 41(5): 272-89.

Dhar R. Pneumonia: review of guidelines. J Assoc Physicians India. 2012 Jan; 60 Suppl: 25-8.

Miskovich-Riddle L, Keresztes PA. CAP management guidelines. Nurse Pract. 2006 Jan; 31(1):43-7.

Moran GJ, Talan DA, Abrahamian FM. Diagnosis and management of pneumonia in the emergency department. Infect Dis Clin North Am. 2008 Mar; 22(1): 53-72.

Boyd AR, Orihuela CJ. Dysregulated inflammation as a risk factor for pneumonia in the elderly. Aging Dis. 2011 Dec; 2(6): 487-500.

Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J. 2006 Feb; 27(2): 397-412.

American Thoracic Society, European Respiratory Society. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus classification of the idiopathic interstitial pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001. Am J Respir Crit Care Med. 2002 Jan 15; 165(2): 277-304.

Menéndez R, Torres A, Aspa J, Capelastegui A, Prat C, Rodríguez de Castro F, et al. Community acquired pneumonia: New guidelines of the Spanish Society of Chest Diseases and Thoracic Surgery (SEPAR). Arch Bronconeumol. 2010 Oct; 46(10): 543-58.

Preventing pneumococcal disease: a Canadian consensus conference. 16-18 February 1998. Can Commun Dis Rep. 1999 Feb 15; 25(4): 25-35.

Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, et al. Guidelines for the management of adults with community-acquired pneumonia: Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med. 2001 Jun; 163(7): 1730-54.

Erdem H, Kocak-Tufan Z, Yilmaz O, Karakurt Z, Cilli A, Turkan H, et al. The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study. Ann Clin Microbiol Antimicrob. 2014 Jan 8; 13: 5.

Miravitlles M, Murio C, Guerrero T, Gisbert R. Costs of chronic bronchitis and COPD: a 1-year follow-up study. Chest. 2003 Mar; 123(3): 784-91.

Mapel D, Schum M, Yood M, Brown J, Miller D, Davis K. Pneumonia among COPD patients using inhaled corticosteroids and long-acting bronchodilators. Prim Care Respir J. 2010 Jun; 19(2): 109-17.

Nuorti JP, Butler JC, Farley MM, Harrison LH, McGeer A, Kolczak MS, Breiman RF. Cigarette smoking and invasive pneumococcal disease. Active Bacterial Core Surveillance Team. N Engl J Med. 2000 Mar 9; 342(10): 681-9.

Jover F, Cuadrado JM, Andreu L, Martínez S, Cañizares R, de la Tabla VO, et al. A comparative study of bacteremic and non-bacteremic pneumococcal pneumonia. Eur J Intern Med. 2008 Jan; 19(1): 15-21.

Rosón B, Carratalà J, Verdaguer R, Dorca J, Manresa F, Gudiol F. Prospective study of the usefulness of sputum Gram stain in the initial approach to community-acquired pneumonia requiring hospitalization. Clin Infect Dis. 2000 Oct; 31(4): 869-74.

Waterer GW, Wunderink RG. The influence of the severity of community-acquired pneumonia on the usefulness of blood cultures. Respir Med. 2001 Jan; 95(1): 78-82.

Afshar N, Tabas J, Afshar K, Silbergleit R. Blood cultures for community-acquired pneumonia: are they worthy of two quality measures?: A systematic review. J Hosp Med. 2009 Feb; 4(2): 112-23.

Domínguez J, Galí N, Matas L, Pedroso P, Blanco S, Giménez M, et al. PCR detection of Streptococcus pneumoniae DNA in serum samples for pneumococcal pneumonia diagnosis. Clin Microbiol Infect. 2001 Mar; 7(3): 164-6.

Leroy O, Santré C, Beuscart C, Georges H, Guery B, Jacquier JM, Beaucaire G. A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit. Intensive Care Med. 1995 Jan; 21(1): 24-31.

Saldias PF, Pavie GJ. Evaluación de la gravedad en la neumonía del adulto adquirida en la comunidad. Rev Chil Enferm Respir. 2005; 21(2): 103-10.

Eccles S, Pincus C, Higgins B, Woodhead M, Guideline Development Group. Diagnosis and management of community and hospital acquired pneumonia in adults: summary of NICE guidance. BMJ. 2014 Dec 3; 349: g6722.

Lim WS, Woodhead M, British Thoracic Society. British Thoracic Society adult community acquired pneumonia audit 2009/10. Thorax. 2011 Jun; 66(6): 548-9.

Aliberti S, Mantero M, Mirsaeidi M, Blasi F. The role of vaccination in preventing pneumococcal disease in adults. Clin Microbiol Infect. 2014 May; 20 Suppl 5: 52-8.

Domínguez A, Salleras L, Cardeñosa N, Ciruela P, Carmona G, Martínez A, et al. The epidemiology of invasive Streptococcus pneumoniae disease in Catalonia (Spain). A hospital-based study. Vaccine. 2002 Jul 26; 20(23-24): 2989-94.

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010 Jan;33 Suppl 1:S62-9.

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Booth G, Cheng AY. Clinical practice guidelines: Methods. Can J Diabetes. 2013 Apr; 37 Suppl 1: S4-7.

Zitkus BS. Update on the American Diabetes Association Standards of medical care. Nurse Pract. 2014 Aug 16; 39(8): 22-32.

International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010 Mar; 33(3): 676-82.

Little RR, Rohlfing CL, Wiedmeyer HM, Myers GL, Sacks DB, Goldstein DE, et. The national glycohemoglobin standardization program: a five-year progress report. Clin Chem. 2001 Nov; 47(11): 1985-92.

International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009 Jul; 32(7): 1327-34.

Arce P, Galvis E, Espinal C, Mojica J. Mortalidad y morbilidad por neumonía según grupos de edad, localidad y por causa asociada a diabetes en Bogotá 1999-2007. Rev Colomb Neumol. 2008; 20(3): 82-91.

McDonald HI, Nitsch D, Millett ER, Sinclair A, Thomas SL. New estimates of the burden of acute community-acquired infections among older people with diabetes mellitus: A retrospective cohort study using linked electronic health records. Diabet Med. 2014 May; 31(5): 606-14.

Fisher-Hoch SP, Mathews CE, McCormick JB. Obesity, diabetes and pneumonia: the menacing interface of non-communicable and infectious diseases. Trop Med Int Health. 2013 Dec; 18(12): 1510-19.

Hirata Y, Tomioka H, Sekiya R, Yamashita S, Kaneda T, Kida Y, et al. Association of hyperglycemia on admission and during hospitalization with mortality in diabetic patients admitted for pneumonia. Intern Med. 2013; 52(21): 2431-8.

McAlister FA, Majumdar SR, Blitz S, Rowe BH, Romney J, Marrie TJ. The relation between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia. Diabetes Care. 2005 Apr; 28(4): 810-5.

Lepper PM, Ott S, Nüesch E, von Eynatten M, Schumann C, Pletz MW, et al. Serum glucose levels for predicting death in patients admitted to hospital for community acquired pneumonia: prospective cohort study. BMJ. 2012 May 28; 344: e3397.

Yandiola PP, Capelastegui A, Quintana J, Diez R, Gorordo I, Bilbao A, et al. Prospective comparison of severity scores for predicting clinically relevant outcomes for patients hospitalized with community-acquired pneumonia. Chest. 2009 Jun; 135(6): 1572-9.

Metersky ML, Waterer G, Nsa W, Bratzler DW. Predictors of in-hospital vs postdischarge mortality in pneumonia. Chest. 2012;142(2):476-81.

Fine MJ, Smith MA, Carson CA, Mutha SS, Sankey SS, Weissfeld LA, Kapoor WN. Prognosis and outcomes of patients with community-acquired pneumonia: A meta-analysis. JAMA. 1996; 275(2):134-41.

Guidelines for the management of community-acquired pneumonia in adults admitted to hospital. The British Thoracic Society. Br J Hosp Med. 1993 Mar 3-16; 49(5): 346-50

Lau D, Eurich DT, Majumdar SR, Katz A, Johnson JA. Effectiveness of influenza vaccination in working-age adults with diabetes: a population-based cohort study. Thorax. 2013 Jul; 68(7): 658-63.

Publicado
2015-09-01
Sección
ARTICULOS ORIGINALES