Prediction Model for Severe Community-acquired Pneumonia Development among Patients with Diabetes Mellitus

IntroductionDiabetes is an independent risk factor for the development of severe community-acquired pneumonia (CAP) and associated with pneumonia-related hospitalization as well as mortality. Here, we assessed several selected biomarkers to determine their predictive value for progression to severe CAP among diabetic patients. Research design and methodsA retrospective cohort study of diabetic patients with CAP was conducted at a tertiary teaching hospital. The prediction model group (N=100) comprised patients registered between January 2015 to December 2016. Multivariate analysis was performed to identify predictive biomarkers from this cohort. The validation group (N=108) comprised the patients between January 2017 to February 2019. Predictive performance was assessed in the validation group. ResultsA total of 208 diabetic inpatients with CAP were recruited. Further multivariate analysis showed that C-reactive protein (CRP), absolute lymphocyte count (ALC), immunoglobulin (IgM), and HbA1C at admission were independently associated with progression to severe CAP in diabetic patients during hospitalization. The prediction model =0.0179555*CRP+1.975918* HbA1C-2.879364* ALC -0.026255* IgM - 8.220555. The area under ROC (AUROC) curve in the validation group was 0.851 (0.781-0.921) with statistical significance (P<.05). ConclusionsIn diabetic patients with CAP, a combination of CRP, ALC, IgM, and HbA1C at admission could be used to predict the progression to severe CAP. O_TEXTBOXSignificance of this studyO_ST_ABSWhat is already known about this subject?C_ST_ABSO_LIDiabetes is an independent risk factor for the development of severe community-acquired pneumonia (CAP) and associated with pneumonia-related hospitalization as well as mortality. C_LIO_LIIt is essential to identify these patients early and prevent them from progressing to SCAP to improve clinical outcomes. C_LI What are the new findings?O_LIC-reactive protein (CRP), absolute lymphocyte count (ALC), immunoglobulin (IgM), and HbA1C at admission were independently associated with progression to severe CAP in diabetic patients during hospitalization. C_LIO_LIThe prediction model = 0.0179555*CRP+1.975918* HbA1C-2.879364* ALC -0.026255* IgM - 8.220555. C_LIO_LIThe area under ROC (AUROC) curve in the validation group was 0.851 (0.781-0.921) with statistical significance (P<.05). C_LI How might these results change the focus of research or clinical practice?O_LIIn patients with diabetes and CAP, HbA1C, CRP, ALC, IgM at admission, and their combination could be used to predict the progression to severe CAP during hospitalization with good accuracy. C_LIO_LIDue to the included biomarkers are common, our finding may be performed well in clinical practice and then improve the early management of diabetic patients with CAP. C_LI C_TEXTBOX