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- Title
Hyperglycemia and Neutropenic Infections during Bone Marrow Transplantation.
- Authors
Derr, Rachel L.; Hsiao, Victoria C.; Saudek, Christopher D.
- Abstract
Patients undergoing bone marrow transplantation (BMT) constitute an important but previously unstudied population for evaluating the association between hyperglycemia and infection. Because BMT patients become highly immunosuppressed during hospitalization, they are particularly vulnerable to serious infections and preventing such infections is critical to improving clinical outcomes in these patients. Included in this nonconcurrent prospective cohort study were a total of 382 adult patients, 25 (6.5%) with a previous history of diabetes, who underwent allogeneic or autologous BMT from 2002 to 2006 at an urban university hospital and had no evidence of infection prior to the onset of neutropenia (absolute neutrophil count <500/mm3). After neutropenia developed, 84 patients (22.0%) showed evidence of at least one infection, including bloodstream infections (13.3%), pneumonia (7.6%), clostridium difficile colitis (3.1%), urinary tract infections (2.1%), and sinusitis (1.3%). The median of the entire population's average glucose, calculated from all hospital laboratory and bedside measurements taken between admission and the date of neutropenia, was 108 mg/dl (range 83 - 255 mg/dl). For every 10 mg/dl increase in mean glycemia, the risk of any infection increased by 11% [95% CI: 2% - 21%, p = 0.016] and the risk of bloodstream infection increased by 18% [95% CI: 7% - 29%, p = 0.001], after adjusting for age, sex, race, cancer type, and transplant procedure type. For the 71 individuals (18.6%) with at least one glucose result greater than or equal to 200 mg/dl during this period, the odds ratios for developing any infection and bloodstream infections were 1.99 [95% CI: 1.10 - 3.59, p = 0.023] and 2.45 [95% CI: 1.24 - 4.89, p = 0.010], respectively. In conclusion, in a predominantly non-diabetic population that is highly susceptible to infection, hyperglycemia is independently associated with a two-fold increased risk of developing any infection, particularly bacteremia. Tight glycemic control during BMT may play an important role in reducing infection risk.
- Publication
Diabetes, 2007, Vol 56, pA252
- ISSN
0012-1797
- Publication type
Academic Journal