title: Diabetes hinders community-acquired pneumonia outcomes in hospitalized patients.
abstract: OBJECTIVE
  This study aimed to estimate the prevalence of diabetes mellitus (DM) in hospitalized patients with community-acquired pneumonia (CAP) and its impact on hospital length of stay and in-hospital mortality.
  
  
  METHODS
  We carried out a retrospective, nationwide register analysis of CAP in adult patients admitted to Portuguese hospitals between 2009 and 2012. Anonymous data from 157 291 adult patients with CAP were extracted from the National Hospital Discharge Database and we performed a DM-conditioned analysis stratified by age, sex and year of hospitalization.
  
  
  RESULTS
  The 74 175 CAP episodes that matched the inclusion criteria showed a high burden of DM that tended to increase over time, from 23.7% in 2009 to 28.1% in 2012. Interestingly, patients with CAP had high DM prevalence in the context of the national DM prevalence. Episodes of CAP in patients with DM had on average 0.8 days longer hospital stay as compared to patients without DM (p<0.0001), totaling a surplus of 15 370 days of stay attributable to DM in 19 212 admissions. In-hospital mortality was also significantly higher in patients with CAP who have DM (15.2%) versus those who have DM (13.5%) (p=0.002).
  
  
  CONCLUSIONS
  Our analysis revealed that DM prevalence was significantly increased within CAP hospital admissions, reinforcing other studies' findings that suggest that DM is a risk factor for CAP. Since patients with CAP who have DM have longer hospitalization time and higher mortality rates, these results hold informative value for patient guidance and healthcare strategies.
authors.affiliation: APDP-Diabetes Portugal (Education and Research Centre/APDP-ERC), Lisboa, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School-FCM, Universidade Nova de Lisboa, Lisboa, Portugal; Instituto Gulbenkian de Ciência, Oeiras, Portugal.
authors.forename: M
authors.identifier: 0000-0001-8360-6806
authors.initials: M
authors.lastname: Martins
authors.affiliation: APDP-Diabetes Portugal (Education and Research Centre/APDP-ERC) , Lisboa , Portugal.
authors.forename: J M
authors.initials: JM
authors.lastname: Boavida
authors.affiliation: APDP-Diabetes Portugal (Education and Research Centre/APDP-ERC), Lisboa, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School-FCM, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: J F
authors.initials: JF
authors.lastname: Raposo
authors.affiliation: Service of Pneumology , Hospital Pulido Valente, Centro Hospitalar Lisboa Norte , Lisboa , Portugal.
authors.forename: F
authors.initials: F
authors.lastname: Froes
authors.affiliation: Department of Epidemiology , Instituto Nacional de Saúde Dr. Ricardo Jorge , Lisboa , Portugal.
authors.forename: B
authors.initials: B
authors.lastname: Nunes
authors.affiliation: APDP-Diabetes Portugal (Education and Research Centre/APDP-ERC), Lisboa, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School-FCM, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: R T
authors.initials: RT
authors.lastname: Ribeiro
authors.affiliation: APDP-Diabetes Portugal (Education and Research Centre/APDP-ERC), Lisboa, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School-FCM, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: M P
authors.identifier: 0000-0002-2549-0275
authors.initials: MP
authors.lastname: Macedo
authors.affiliation: Instituto Gulbenkian de Ciência , Oeiras , Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Penha-Gonçalves
keywords: Adult Diabetes; Community Health; Risk Factors