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Diabetes Care. 2008 Oct;31(10):1972-7. doi: 10.2337/dc08-0574. Epub 2008 Jul 23.

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

Author information

1
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.

PMID:
18650374
PMCID:
PMC2551637
DOI:
10.2337/dc08-0574
[Indexed for MEDLINE]
Free PMC Article

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