钠-葡萄糖共转运蛋白-2抑制剂与二肽基肽酶-4抑制剂对肺炎无心力衰竭后住院死亡率的影响：一项老年糖尿病患者的回顾性队列研究

IF 2.4 Q2 RESPIRATORY SYSTEM Respiratory investigation Pub Date : 2025-01-01 DOI:10.1016/j.resinv.2024.11.016

Hiroki Maki , Toshiaki Isogai , Nobuaki Michihata , Hiroki Matsui , Kiyohide Fushimi , Hideo Yasunaga

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引用次数: 0

摘要

背景：钠-葡萄糖共转运蛋白-2抑制剂（SGLT2i）可能有助于改善成人糖尿病和肺炎患者的临床结果，因为它们具有潜在的抗炎作用。研究SGLT2i与二肽基肽酶-4抑制剂（DPP-4i）相比，是否与肺炎无心力衰竭后较低的住院死亡率相关。方法：使用日本诊断程序组合数据库，回顾性识别2016年4月至2020年10月因肺炎入院并接受SGLT2i或DPP-4i治疗的年龄≥65岁的糖尿病患者。然后，我们比较了SGLT2i组和DPP-4i组之间的住院死亡率、机械通气需求和出院地点（家中以外），使用多变量logistic回归分析，拟合了广义估计方程。结果：我们分析了27334例患者的资料(平均年龄78.8岁；男性，71.2%)，其中定期接受SGLT2i和DPP-4i治疗的患者分别为535例和26799例。SGLT2i组和DPP-4i组住院死亡率无显著差异(3.4% vs. 5.9%；优势比[OR]， 0.64；95%可信区间[CI]， 0.40-1.05)，机械通气需求(1.5% vs. 1.8%；或者,0.78;95%Cl, 0.39-1.59)，排放到家庭以外的地方(8.1%比14.1%；或者,0.72;cl 95%, 0.51 - -1.02)。在体重亚组中，糖尿病治疗与住院死亡率之间的关联仍然不显著(体重不足：OR， 0.47；95% cl, 0.13 - -1.67;正常体重：OR， 0.66；95% cl, 0.34 - -1.25;超重/肥胖：OR 1.06；cl 95%, 0.43 - -2.65)。结论：与使用DPP-4i相比，住院合并肺炎无心力衰竭的糖尿病患者定期使用SGLT2i可能与改善住院死亡率结果无关。

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Sodium-glucose co-transporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors on in-hospital mortality following pneumonia without heart failure: A retrospective cohort study of older adults with diabetes

Background

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) may contribute to better clinical outcomes in adults with diabetes and pneumonia owing to their potential anti-inflammatory effects. To investigate whether SGLT2i are associated with lower in-hospital mortality following pneumonia without heart failure than dipeptidyl peptidase-4 inhibitors (DPP-4i).

Methods

Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified patients with diabetes aged ≥65 years treated with SGLT2i or DPP-4i who were admitted and managed for pneumonia from April 2016 to October 2020. We then compared in-hospital mortality, the need for mechanical ventilation, and discharges to locations (other than home) between the SGLT2i and DPP-4i groups using multivariable logistic regression analyses fitted with generalized estimating equations.

Results

We analyzed the data of 27,334 patients (mean age, 78.8 years; male, 71.2%), including 535 and 26,799 patients regularly treated with SGLT2i and DPP-4i, respectively. No significant differences were observed between the SGLT2i and DPP-4i groups in in-hospital mortality rate (3.4% vs. 5.9%; odds ratio [OR], 0.64; 95% confidence interval [CI], 0.40–1.05), the need for mechanical ventilation (1.5% vs. 1.8%; OR, 0.78; 95%Cl, 0.39–1.59), and discharge to locations other than home (8.1% vs. 14.1%; OR, 0.72; 95%Cl, 0.51–1.02). The association between the diabetic treatment and in-hospital mortality remained insignificant across weight subgroups (underweight: OR, 0.47; 95%Cl, 0.13–1.67; normal weight: OR, 0.66; 95%Cl, 0.34–1.25; and overweight/obesity: OR 1.06; 95%Cl, 0.43–2.65).

Conclusions

Regular SGLT2i use in patients with diabetes admitted with pneumonia without heart failure may not be associated with improved in-hospital mortality outcomes compared with DPP-4i use.

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