title: Antecedent hyperglycemia is associated with an increased risk of neutropenic infections during bone marrow transplantation.
abstract: OBJECTIVE
  To use bone marrow transplantation (BMT) as a model for testing the association between hyperglycemia and infection.
  
  
  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.
authors.affiliation: Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. rderr@jhmi.edu.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Derr
authors.forename: Victoria C
authors.initials: VC
authors.lastname: Hsiao
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Saudek
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D007239:Infections / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification / Q000601:surgery; D009503:Neutropenia / Q000150:complications / Q000453:epidemiology*; D019095:Point-of-Care Systems; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: D001786:Blood Glucose