Comparison of Clinical, Laboratory and Radiological Characteristics in Hospitalized Diabetic and Non Diabetic Patients with Community Acquired Pneumonia

Document Type : Original Article


1 Resident of Infectious diseases and Tropical medicine,Department of Infectious and Tropical Disease

2 Chronic Renal Failure Research Center, Department of Pediatric Nephrology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran


Background and Objective: community-acquired pneumonia (CAP) is a life-threatening disease in patients with diabetes mellitus (DM). DM is associated with an increased susceptibility to infection and increased morbidity and mortality. The aim of the present study was to provide information on clinical, laboratory and radiological characteristics and the outcome of CAP in patients with DM.
Subjects and Methods:   During a two years period (2009-2010), we studied the clinical, laboratory and radiological characteristics, the spectrum of causative agents and the outcomes of 264 cases of CAP. Data derived from 42 patients with DM were analyzed and compared with data obtained from the remaining CAP patients.
Results:Patients with DM were significantly older (P=0.02) and were more frequently associated with other co morbid conditions such as cardiac failure and hypertension (P<0.0001). Fever (P<0.0001) and dyspnea (P=0.03) were more frequent in DM patients. Lobar consolidation, bilateral infiltration and plural effusion were the most common imaging findings in chest radiography. Pleural effusion (P=0.002) and lobar consolidation ((P=0.02) were more frequently found in DM patients. By contrast, the incidence of the main etiologic agents such as S.pneumoniae (P<0.0001`) and K. pneumoniae (P=0.001) among DM patients showed significant differences in relation to the remaining patients. In the subgroup of patients with DM, mortality was significantly higher than no-diabetics (P=0.03).
Conclusions: In patients with CAP, DM is associated with a different clinical, laboratory and radiological characteristics, and with higher rate of cardiovascular complication such as congestive heart failure and hypertension, increasing the rate of mortality.


1-File TM. Community-acquired pneumonia. Lancet2003;362(9400):1991- 2001. PMID: 14683661 [PubMed - indexed for MEDLINE]
2-Simpson SH, Marrie TJ, Majumdar SR. Do guidelines guide pneumonia practice? Systematic review of interventions and barriers to best practice in the management of community-acquired pneumonia. Respir Care Clin N Am 2005;11(1):1–13.
3-Kaplan V, Angus DC, Griffin MF, Clermont G, Scott Watson R, Linde-Zwirble WT. Hospitalized community-acquired pneumonia in the elderly: age-and sex-related patterns of care and outcome in the United States. Am J Respir Crit Care Med 2002;165(6):766-72.
4-Ruiz M, Ewig S, Marcos MA, Martinez JA, Arancibia F, Mensa J, et al. Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. Am J Respir Crit Care Med 1999;160(2):397–405.
5-Lim WS, Macfarlane JT, Boswell TC, Harrison TJ, Rose D, Leinonen M, et al. Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines. Thorax 2001;56(4):296–301.
6-Arancibia F, Bauer TT, Ewig S, Mensa J, Gonzalez J, Niederman MS, et al. Community-acquired pneumonia due to gram-negative bacteria and Pseudomonas aeruginosa: incidence, risk, and prognosis. Arch Intern Med 2002;162 (16):1849–58.
7-Donowitz GR. Acute pneumonia. In: Mandel GI, Bonnet JE, Dolin R, eds. Principles and Practice of Infectious Disease. 7th ed. New York: Churchill Livingstone; 2010. P. 891-916.
8-Falguera M, Pifarre R, Martin A, Sheikh A, Moreno A. Etiology and outcome of community-acquired pneumonia in patients with diabetes mellitus. Chest 2005;128(5):3233-9.
9-Marrie TJ, Lau CY, Wheeler SL, Wong CJ, Feagan BG. Predictors of symptom resolution in patients with community-acquired pneumonia. Clin  Infect Dis 2000;31(6):1362-7.
10-Butt SSwiatlo E .Treatment of community-acquired pneumonia in an ambulatory setting. Am J Med. 2011;124(4):297-300.
11-Powers AC. Diabetes mellitus. In: Braunwald E, Fauci AS, Kasper DL, Hauser SL,Longo DL,Jamson JL(eds). Harrison's principles of internal medicine. 15th ed. New York: McGraw-Hill; 2001. P. 2109–37.
12-Esteghamati A, Ashraf H, Khalilzadeh O, Rashidi A, Mohammad K, Asgari F, et al. Trends of diabetes according to body mass index levels in Iran: results of the national Surveys of Risk Factors of Non-Communicable Diseases (1999-2007). Diabet Med 2010;27(11):1233-40.
13-Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allanic H, Genetet B. Impaired leucocyte functions in diabetic patients. Diabet Med 1997;14(1):29–34.
14-McMahon MM, Bistrian BR. Host defenses and susceptibility to infection in patients with diabetes mellitus. Infect Dis Clin North Am 1995;9:1–9.
15-McAlister SR, 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;28(4):810-5.
16-Woodhead M. Assessment of illness severity in community acquired pneumonia: a useful new prediction tool. Thorax 2003;58(5):371-2.
17-Koivula I, Sten M, Makela PH. Prognosis after community-acquired pneumonia in the elderly: a population-based 12-year follow-up study. Arch Intern Med 1999;159(14):1550-5.
18-Joshi N, Caputo GM, Weitekamp MR, Karchmer AW. Infections in patients with diabetes mellitus. N Engl J Med 1999;341(25):1906–12.
19-Jafari S, Soltanpour F, Soudbakhsh A, Safavi E. Rokni Yazdi H, Navipour R,et al. [Community-Acquired Pneumonia: A Comparison between elderly and nonelderly patients]. Tehran Univ Med J 2006;64(8):74-80. [In Persian]
20-Flannery MT, McCool MJ. Community-acquired pneumonia guidelines and resident behavior. Am J Med 2005;118(8):929-30.
21-Aleva RM, Boersma WG; Dutch Thoracic Society. [Guideline 'Diagnosis and treatment of community-acquired pneumonia' from the Dutch Thoracic Society].  Ned Tijdschr Geneeskd 2005;149(45):2501-7. [In Dutch]