Glycemic Status and Infection Risk in Nondiabetic Autologous Hematopoietic Cell Transplantation Recipients.
BACKGROUND
Patients undergoing hematopoietic cell transplantation (HCT) for hematological malignancies experience a number of challenges during treatment. There is growing evidence that malglycemia (hyperglycemia, hypoglycemia, and/or increased glycemic variability) contributes to HCT-related complications, even in patients without preexisting diabetes. The purpose of this pilot study was to investigate factors influencing glycemic status and associated infection occurrences in nondiabetic autologous HCT recipients.


METHODS
Oncology patients without preexisting diabetes treated with autologous HCT at a National Cancer Institute-designated cancer center were followed from admission through discharge or 28 days post-HCT. Patients had morning fasting laboratory tests. Descriptive statistics and Cox proportional hazards models were used to examine associations between BG levels and risk for infection while adjusting for baseline covariates including age, body mass index (BMI), cumulative glucocorticoid dose, and diagnosis.


RESULTS
The sample included 28 female and 25 male predominately non-Hispanic White patients (mean age 55.7 years, SD = 11.32). Blood glucose (BG) range was 35-325 mg/dl. Twenty-three patients incurred at least one infection. BMI ≥ 25 kg/m(2) was associated with high BG and infections. In the multivariate Cox model, an increase of 1 interquartile range in BG 2 days before infection was associated with a moderately increased risk of infection (hazard ratio = 1.44, p = .008).


CONCLUSIONS
Understanding the contributors to and consequences of malglycemic events can lead to better protocols for identifying patients at greater risk for infection. Further investigation is warranted for interventions to mitigate BG events for improved outcomes.
['Hammer|Marilyn J|MJ|', "D'Eramo Melkus|Gail|G|", 'Knobf|M Tish|MT|', 'Casper|Corey|C|', 'Fletcher|Jason|J|', 'Cleland|Charles M|CM|']
D058186:Acute Kidney Injury D000328:Adult D000368:Aged D001786:Blood Glucose D005260:Female D006402:Hematologic Diseases D018380:Hematopoietic Stem Cell Transplantation D006801:Humans D006943:Hyperglycemia D007239:Infections D008297:Male D008875:Middle Aged
glycemic status infections autologous hematopoietic cell transplantation