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Antecedent hyperglycemia is associated with an increased risk of neutropenic infections during bone marrow transplantation.

Derr RL, Hsiao VC, Saudek CD - Diabetes Care (2008)

Bottom Line: Mean glucose was calculated from central laboratory and bedside measurements taken before neutropenia; the primary outcome was neutropenic infections.In patients who did not receive glucocorticoids during neutropenia, each 10 mg/dl increase in mean preneutropenia glucose was associated with an odds ratio of 1.08 (95% CI 0.98-1.19) (P = 0.14) for any infection and 1.15 (1.03-1.28) (P = 0.01) for bloodstream infections, after adjusting for age, sex, race, year, cancer diagnosis, transplant type, and total glucocorticoid dose before neutropenia.There was no association between mean glycemia and long length of hospital stay, critical status designation, or mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. rderr@jhmi.edu.

ABSTRACT

Objective: To use bone marrow transplantation (BMT) as a model for testing the association between hyperglycemia and infection.

Research design and methods: This cohort study included 382 adults (6.5% with diabetes) who had no evidence of infection before neutropenia during BMT. Mean glucose was calculated from central laboratory and bedside measurements taken before neutropenia; the primary outcome was neutropenic infections.

Results: Eighty-four patients (22%) developed at least one neutropenic infection, including 51 patients (13%) with bloodstream infections. In patients who did not receive glucocorticoids during neutropenia, each 10 mg/dl increase in mean preneutropenia glucose was associated with an odds ratio of 1.08 (95% CI 0.98-1.19) (P = 0.14) for any infection and 1.15 (1.03-1.28) (P = 0.01) for bloodstream infections, after adjusting for age, sex, race, year, cancer diagnosis, transplant type, and total glucocorticoid dose before neutropenia. In those who received glucocorticoids during neutropenia (n = 71), the adjusted odds ratio associated with a 10 mg/dl increase in mean glucose was 1.21 (1.09-1.34) (P < 0.0001) for any infection and 1.24 (1.11-1.38) (P < 0.0001) for bloodstream infections. There was no association between mean glycemia and long length of hospital stay, critical status designation, or mortality.

Conclusions: In a BMT population highly susceptible to infection, there was a continuous positive association between mean antecedent glycemia and later infection risk, particularly in patients who received glucocorticoids while neutropenic. Tight glycemic control during BMT and glucocorticoid treatment may reduce infections.

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A: Predicted odds ratios for any infection for increasing mean preneutropenia glucose compared with a mean glucose of 100 mg/dl. B: Predicted odds ratios for bloodstream infection. (▴), glucocorticoids received during neutropenia (n = 71); (▪), glucocorticoids not received during neutropenia (n = 311). Odds ratios were calculated using multivariate logistic regression models, which included age, sex, race, cancer diagnosis, transplant type, year of transplant, and cumulative glucocorticoid dose before neutropenia onset. The values chosen for the covariates were the median in the case of continuous variables and the most frequent category in the case of categorical variables.
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f1: A: Predicted odds ratios for any infection for increasing mean preneutropenia glucose compared with a mean glucose of 100 mg/dl. B: Predicted odds ratios for bloodstream infection. (▴), glucocorticoids received during neutropenia (n = 71); (▪), glucocorticoids not received during neutropenia (n = 311). Odds ratios were calculated using multivariate logistic regression models, which included age, sex, race, cancer diagnosis, transplant type, year of transplant, and cumulative glucocorticoid dose before neutropenia onset. The values chosen for the covariates were the median in the case of continuous variables and the most frequent category in the case of categorical variables.

Mentions: After adjusting for age, sex, race, cancer type, transplant type, year of transplant, and total glucocorticoid dose received before neutropenia, antecedent hyperglycemia was significantly associated with an increased rate of infection. The odds ratio for any infection was 1.11 (95% CI 1.01–1.21) (P = 0.023) for every 10 mg/dl increase in mean preneutropenia glycemia (Table 3). This relationship between mean glucose and neutropenic infections was modified by glucocorticoid treatment during neutropenia. For every 10 mg/dl increase in mean preneutropenia glucose, the odds ratio for any infection in 311 patients who did not receive glucocorticoids while neutropenic was 1.08 (0.98–1.19) (P = 0.136), whereas the odds ratio in 71 patients who did receive steroids was 1.21 (1.09–1.33) (P < 0.00001). Figure 1A depicts the results of applying our multivariate logistic regression model for a subject with the most frequently encountered characteristics. In patients who received glucocorticoids during neutropenia, a preneutropenia mean glucose of 200 vs. 100 mg/dl was associated with a 6.5 times higher (95% CI 2.0–21.2) risk of infection.


Antecedent hyperglycemia is associated with an increased risk of neutropenic infections during bone marrow transplantation.

Derr RL, Hsiao VC, Saudek CD - Diabetes Care (2008)

A: Predicted odds ratios for any infection for increasing mean preneutropenia glucose compared with a mean glucose of 100 mg/dl. B: Predicted odds ratios for bloodstream infection. (▴), glucocorticoids received during neutropenia (n = 71); (▪), glucocorticoids not received during neutropenia (n = 311). Odds ratios were calculated using multivariate logistic regression models, which included age, sex, race, cancer diagnosis, transplant type, year of transplant, and cumulative glucocorticoid dose before neutropenia onset. The values chosen for the covariates were the median in the case of continuous variables and the most frequent category in the case of categorical variables.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2551637&req=5

f1: A: Predicted odds ratios for any infection for increasing mean preneutropenia glucose compared with a mean glucose of 100 mg/dl. B: Predicted odds ratios for bloodstream infection. (▴), glucocorticoids received during neutropenia (n = 71); (▪), glucocorticoids not received during neutropenia (n = 311). Odds ratios were calculated using multivariate logistic regression models, which included age, sex, race, cancer diagnosis, transplant type, year of transplant, and cumulative glucocorticoid dose before neutropenia onset. The values chosen for the covariates were the median in the case of continuous variables and the most frequent category in the case of categorical variables.
Mentions: After adjusting for age, sex, race, cancer type, transplant type, year of transplant, and total glucocorticoid dose received before neutropenia, antecedent hyperglycemia was significantly associated with an increased rate of infection. The odds ratio for any infection was 1.11 (95% CI 1.01–1.21) (P = 0.023) for every 10 mg/dl increase in mean preneutropenia glycemia (Table 3). This relationship between mean glucose and neutropenic infections was modified by glucocorticoid treatment during neutropenia. For every 10 mg/dl increase in mean preneutropenia glucose, the odds ratio for any infection in 311 patients who did not receive glucocorticoids while neutropenic was 1.08 (0.98–1.19) (P = 0.136), whereas the odds ratio in 71 patients who did receive steroids was 1.21 (1.09–1.33) (P < 0.00001). Figure 1A depicts the results of applying our multivariate logistic regression model for a subject with the most frequently encountered characteristics. In patients who received glucocorticoids during neutropenia, a preneutropenia mean glucose of 200 vs. 100 mg/dl was associated with a 6.5 times higher (95% CI 2.0–21.2) risk of infection.

Bottom Line: Mean glucose was calculated from central laboratory and bedside measurements taken before neutropenia; the primary outcome was neutropenic infections.In patients who did not receive glucocorticoids during neutropenia, each 10 mg/dl increase in mean preneutropenia glucose was associated with an odds ratio of 1.08 (95% CI 0.98-1.19) (P = 0.14) for any infection and 1.15 (1.03-1.28) (P = 0.01) for bloodstream infections, after adjusting for age, sex, race, year, cancer diagnosis, transplant type, and total glucocorticoid dose before neutropenia.There was no association between mean glycemia and long length of hospital stay, critical status designation, or mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. rderr@jhmi.edu.

ABSTRACT

Objective: To use bone marrow transplantation (BMT) as a model for testing the association between hyperglycemia and infection.

Research design and methods: This cohort study included 382 adults (6.5% with diabetes) who had no evidence of infection before neutropenia during BMT. Mean glucose was calculated from central laboratory and bedside measurements taken before neutropenia; the primary outcome was neutropenic infections.

Results: Eighty-four patients (22%) developed at least one neutropenic infection, including 51 patients (13%) with bloodstream infections. In patients who did not receive glucocorticoids during neutropenia, each 10 mg/dl increase in mean preneutropenia glucose was associated with an odds ratio of 1.08 (95% CI 0.98-1.19) (P = 0.14) for any infection and 1.15 (1.03-1.28) (P = 0.01) for bloodstream infections, after adjusting for age, sex, race, year, cancer diagnosis, transplant type, and total glucocorticoid dose before neutropenia. In those who received glucocorticoids during neutropenia (n = 71), the adjusted odds ratio associated with a 10 mg/dl increase in mean glucose was 1.21 (1.09-1.34) (P < 0.0001) for any infection and 1.24 (1.11-1.38) (P < 0.0001) for bloodstream infections. There was no association between mean glycemia and long length of hospital stay, critical status designation, or mortality.

Conclusions: In a BMT population highly susceptible to infection, there was a continuous positive association between mean antecedent glycemia and later infection risk, particularly in patients who received glucocorticoids while neutropenic. Tight glycemic control during BMT and glucocorticoid treatment may reduce infections.

Show MeSH
Related in: MedlinePlus