title: Retrospective Comparison of Clinical Characteristics and In-Hospital Outcomes among Diabetic and Non-Diabetic Adults with Acute Pyelonephritis.
abstract: BACKGROUND
  Acute Pyelonephritis (APN) is a common infection in community. Diabetes Mellitus (DM) may have different effect on clinical characteristics and outcomes of APN compared to non-diabetic individuals.
  
  
  OBJECTIVE
  To compare clinical characteristics and assess outcomes of APN patients with and without DM.
  
  
  METHODS
  A retrospective analysis of 122 patients with DM (n=61) and without DM (n=61) was conducted at a single, private, urban set-up from Gujarat, India. Clinical symptoms, laboratory investigations, antibiotics treatment and outcomes in terms of mortality and prolonged hospitalization (10 days and above) were compared in two groups.
  
  
  RESULTS
  Mean age was significantly higher in diabetics than non-diabetics (55.2±12.5 vs 41.5±17.3, p<0.0001) and females were proportionally higher in both groups (65.6% Vs 62.3%, p=0.706). Fever was most frequent symptom (83.6% Vs 90.2%, p=0.283) followed by nausea/vomiting (50.8% Vs 63.9%, p=0.143), dysuria (66.7% Vs 74.4%, p=0.433) and flank pain (8.2 Vs 13.1, p=0.379). Backache/back pain (47.5% Vs 29.5%, p=0.041) and Chronic Kidney Disease (CKD) (63.9% Vs 45.9%, p=0.045) were significantly higher in diabetics than non-diabetics. Mean hospital stay did not vary significantly in two groups (7.0±3.2 Vs 6.50±2.9, p=0.346) but proportion of patients with longer hospital stay was higher in DM (16.4% Vs 8.2%). Elevated white cell count, erythrocyte sedimentation rate, C-reactive protein, serum creatinine and presence of red cell in urine (> 5/ high power field [hpf]) did not vary significantly in two groups. Cephalosporin-beta-lactamase inhibitor (Cefaperazone-Sulbactam/Cefepime-Tazobactam) was the most prescribed antibiotic in both the groups. No deaths were observed in any group during this evaluation period. Only raised ESR (>30 mm/hr) {Odds Ratio (OR): 1.58, 95% Confidence Interval (CI) 1.36-1.82, p=0.004} and presence of CKD (OR: 1.71, 95% CI 1.30-2.25, p=0.008) were found to be the significant predictors of prolonged hospitalization in overall population.
  
  
  CONCLUSIONS
  APN in diabetic and non-diabetic patients has similar clinical characteristics. Impact of diabetes on clinical outcomes of mortality and prolonged hospitalization warrants further investigation in a large, randomized, prospective trial.
authors.affiliation: Consultant Physician, Department of Medicine, Anand Hospital , Nizampura, Vadodara, Gujrat, India .
authors.forename: Shailesh C
authors.initials: SC
authors.lastname: Trivedi
authors.affiliation: Consultant Diabetologist, Department of Medicine, Sumeru Centre , Near Parimal Rly. Crossing, Paldi, Ahmedabad, Gujrat, India .
authors.forename: Sanjeev R
authors.initials: SR
authors.lastname: Phatak
authors.affiliation: Director, Department of Medicine, Anand Hospital , Nizampura, Vadodara, Gujrat, India .
authors.forename: Renu S
authors.initials: RS
authors.lastname: Trivedi
keywords: Chronic kidney disease; Prolonged hospitalization; Risk predictors