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Diabetes mellitus increases mortality in acute pyelonephritis patients: a population study based on the National Health Insurance Claim Data of South Korea for 2010–2014

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Abstract

Objective

Diabetes mellitus has been suspected to increase mortality in acute pyelonephritis (APN) patients and the goal of this study is to verify this suspicion with a large data set based on almost the entire population of South Korea.

Methods

A nationwide cohort study was conducted using a South Korean Health Insurance Review and Assessment Service claim database. We collected demographic and clinical information including comorbidities of patients with APN as the primary discharge diagnosis during 2010–2014. Then we compared the in-hospital mortality and recurrence of APN across the diabetes and non-diabetes groups.

Results

Among 845,656 APN patients, 12.4% had diabetes mellitus. The median age was 65 in the diabetes group, which was much higher than 47 in the non-diabetes group; the female proportion was 91–92% in both groups. The in-hospital mortality rate was higher in the diabetes group (2.6/1000 events in the diabetes group vs. 0.3/1000 in the non-diabetes group, P < 0.001). When covariates (age, sex, and the modified Charlson comorbidity index) were controlled with panel logistic regression, diabetes was still associated with a higher in-hospital mortality in APN patients (OR 2.66, 95% CI 2.19–3.23). The increasing effect of diabetes on in-hospital mortality of APN patients varied greatly with age: the effect was large for age 15–49 (OR 15.06, 95% CI 5.27–43.05), slightly smaller for age 50–64 (OR 12.17, 95% CI 5.71–25.92), and much smaller for age ≥ 65 (OR 2.10, 95% CI 1.72–1.92).

Conclusions

Our data indicate that the mortality of APN is higher in the patients with diabetes and this effect becomes stronger for young patients.

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Acknowledgements

The authors are grateful to anonymous reviewers for their detailed comments.

Funding

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Author notes

  1. Bongyoung Kim and Rangmi Myung contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Korea

    Bongyoung Kim, Gheun-Ho Kim, Jieun Kim & Hyunjoo Pai

  2. Department of Economics, College of Political Science and Economics, Korea University, 145 Anam-ro, Sungbuk-gu, Seoul, 02841, Korea

    Rangmi Myung & Myoung-jae Lee

Authors
  1. Bongyoung Kim
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  2. Rangmi Myung
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  3. Gheun-Ho Kim
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  5. Jieun Kim
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Corresponding authors

Correspondence to Myoung-jae Lee or Hyunjoo Pai.

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The authors declare that they have no conflicts of interests regarding the manuscript.

Ethical statement

The study protocol was approved by the institutional review board of Hanyang University Hospital (IRB number: 2016-01-032) and the requirement for a written informed consent from patients was waived.

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Kim, B., Myung, R., Kim, GH. et al. Diabetes mellitus increases mortality in acute pyelonephritis patients: a population study based on the National Health Insurance Claim Data of South Korea for 2010–2014. Infection 48, 435–443 (2020). https://doi.org/10.1007/s15010-020-01419-2

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  • DOI: https://doi.org/10.1007/s15010-020-01419-2

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