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Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

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Clinical Characteristics Patients Pneumonia with Diabetes Mellitus at General Hospital Jakarta, Indonesia 

Dini Permata Sari*, Ahmad Muflih Maulana, Rangki Astiani

Faculty of Pharmacy, Universitas 17 Augustus 1945 Jakarta, Jakarta 14350, Indonesia

INTRODUCTION

Pneumonia is an acute respiratory infection that occurs in the lung parenchyma, distal to the terminal bronchioles, which includes the respiratory bronchioles, and is accompanied by the consolidation of lung tissue. Lower respiratory tract infections caused the highest mortality occurring largely in patients requiring hospitalization¹. 

In western countries, pneumonia overall is the sixth leading cause of death². In the United States, pneumonia causes death at a rate of 16.1 per 100,000 populations³. A study in Germany stated that the incidence of hospitalized patients was 2.96 per 1000 population with an incidence rate of 7.65 per 1000 population in patients over 60 years⁴. Various epidemiological studies have also reported an annual incidence of community pneumonia of 5-11 people per 1000 population with the number increasing in elderly patients⁵. Research that has been done by Sato et al related to financing showed that the costs incurred for community pneumonia treatment are high according to increasing age or the presence of comorbidities that accompany patients with pneumonia⁶. Pneumonia infections can occur due to several factors, namely age, gender, an impaired immune function such as HIV (Human Immunodeficiency Virus), comorbidities, malnutrition, prolonged hospital stay, and chronic obstructive pulmonary disease⁷. 

Comorbidity is a condition of the presence of other diseases that are experienced together with the main disease. The most common comorbidities in pneumonia patients are hypertension, neuromuscular disease, kidney failure, diabetes mellitus, head injury, and Chronic Obstructive Pulmonary Disease (COPD)⁸. Comorbidities such as diabetes mellitus cause disruption of the body's immune system and are a predisposing factor for various infectious diseases including pneumonia⁹. 

Unfortunately, the information available on the clinical characteristics of pneumonia patients with diabetes mellitus is limited. In particular, we were aware of the lack of data regarding the analysis of the association of clinical characteristics of pneumonia patients with diabetes mellitus. Therefore, we analyzed the clinical findings and outcomes of clinical characteristics in pneumonia patients with diabetes mellitus. The key question discussed in this study is whether there was a relationship between the clinical characteristics of hospitalized pneumonia patients and diabetes mellitus.

METHODS

Patients 

All patients in this study were hospitalized at the general hospital in Jakarta, Indonesia, from June 2020 to June 2021. The patients were all admitted to the hospital because they were infected with pneumonia with diabetes mellitus and suffered from various symptoms, age 17 - 70 years, every patient had completed the relevant laboratory examinations and complete medical record data entered the inclusion criteria. Patients were infected with diseases other than pneumonia, and patients who did not have complete data were excluded.

Data collection and Statistical Analysis 

In this study, data were collected through patient medical records suffering from pneumonia with accompanying diabetes mellitus entered the inclusion criteria from June 2020 to June 2021. The data processing was carried out using statistical software SPSS v25.0. The normality of the distributions of variables was assessed by Kolmogorov-Smirnov and the Shapiro-Wilk tests. The Chi-Square test to see the relationship between the clinical characteristics of patients of pneumonia with diabetes mellitus.   P<0.05 was considered significant.

RESULT 

Table 1: Characteristics of patients pneumonia with diabetes mellitus

Based on the results of research conducted at the general hospital Jakarta from medical records of pneumonia patients with diabetes mellitus from June 2020 - June 2021, the number of pneumonia patients with diabetes mellitus obtained from this study was 66 patients. Based on the data in Table 1, patients who dominate pneumonia with diabetes mellitus were at the age over 65 years as many as 36 patients (54.54%). Based on gender, men were 46 patients (69.70%) and women were 20 patients (30.30%). Based on the results of the data above, the highest number of gender in pneumonia patients was men. The clinical characteristics that were often found in hospitalized pneumonia patients were cough and shortness of breath, which are known in 52 patients (78.79%), and accompanied by fever in 35 patients (53.03%).

Table 2: Results of examination of the blood sugar profile of patients

From the data obtained in Table 2, the results of the examination of blood glucose profiles in hospitalized pneumonia patients which is a parameter in diagnosing diabetes mellitus showed the value of Current Blood Sugar (≥ 200 mg/dl) with the highest patient being 39 patients (59.09%), the HbA1c value (≥ 6.5) with the highest number of patients was 60 patients (90.91%). Based on the results of the Kolmogorov-Smirnova normality test, the relationship of diabetes mellitus with clinical characteristics of pneumonia patients showed that the data were not normally distributed because the variable results of the Diabetes Mellitus laboratory examination had a P value <0.05. For this reason, a non-parametric test is carried out, namely the chi-square test. From the results of the statistical analysis of the chi-square test, the P value = 0.002. based on the values obtained, there was a significant relationship between the clinical characteristics of pneumonia patients with diabetes mellitus at a general hospital in Jakarta for the period June 2020 - June 2021.

DISCUSSION 

Based on the results of the data above, The most common age group in our study was the age over 65 years. Old age is associated with a large number of changes in decreased immune function. This is a very high risk of disease. Humans experience physiological decline after the age of 40 years. One of several studies conducted by Chapman et al found that people over 65 years of age get sick more than 915,000 times each year in the US. They claim that age is one of the important factors for the development of pneumonia¹⁰. Diabetes mellitus often appears after humans enter the vulnerable age. As you get older, the risk of suffering from diabetes mellitus will increase. Diabetes mellitus is one of the comorbid diseases that can affect pneumonia^11,12. The characteristics of patients with pneumonia based on gender were more in men than women. Pneumonia is more common in men, this happens because the diameter of the respiratory tract in men are smaller than in women and there is a differences in the immune system of men and women¹³. Kautzky et al in their study found that there were more men than women and the ratio is higher in favor of men 1.5:1¹⁴. Clinical characteristics that are often found in pneumonia patients with diabetes mellitus as a result of our research were cough, shortness of breath, accompanied by fever. Long et al in their study found the percentage of pneumonia patients was dominated by shortness of breath (79.8%), cough (72.1%), and fever (66.9%). The dominance of pneumonia is characterized by shortness of breath, because the respiratory rate is >30x/minute and oxygen saturation is <90%¹⁵. Increased blood glucose levels in patients can occur due to several factors such as increasing age, a history of diabetes mellitus, an unhealthy lifestyle, and the main disease¹⁶.    HbA1c is a substance formed from the reaction between glucose and hemoglobin. The higher the blood sugar level, the more hemoglobin molecules are associated with sugar. The HbA1c examination is carried out to control the sugar levels of patients with diabetes mellitus so that blood sugar levels can be controlled properly, compared with not having diabetes, having diabetes in combination with a 9% HbA1c level was associated with a 60% increased risk of pneumonia-related hospitalization and having diabetes in combination with a 7% HbA1c level was associated with a 22% increased risk^17,18,19. When analysing the relationship between diabetes mellitus with clinical characteristics of pneumonia patients, there was a significant relationship between the clinical characteristics of pneumonia patients with diabetes mellitus. This is comparable to a study conducted by Hirata et al found a relationship between the incidence of death in pneumonia patients and the presence of diabetes melitus¹⁹.

CONCLUSION 

Based on the research, it can be concluded that the prevalence of pneumonia patients with diabetes mellitus was 66 patients. From the statistical analysis, the chi-square test showed a significant relationship between the clinical characteristics of pneumonia and diabetes mellitus.

CONFLICT OF INTEREST 

All authors have nothing to declare.

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