title: The impact of hyperglycemia on hematopoietic cell transplantation outcomes: an integrative review.
abstract: OBJECTIVE
  Many patients undergoing hematopoietic cell transplantation (HCT) for hematologic malignancies experience hyperglycemic events during treatment, leading to adverse outcomes. Understanding how hyperglycemia during the acute HCT treatment phase impacts outcomes is vital for preventing and mitigating adverse events. This integrative review evaluates the impact of hyperglycemia on adult patients undergoing HCT.
  
  
  METHODS
  PubMed, MEDLINE®, and CINAHL® electronic databases were used to identify relevant articles.Data Evaluation: The final sample for this integrative review included 12 empirical quantitative reports of clinical patient outcomes. Of the 12, 10 are retrospective, 1 is case-control, and 1 is prospective.
  
  
  METHODS
  Content analysis was used to synthesize and summarize findings.Presentation of Findings: A review of published literature found associations between hyperglycemia and infection, time to engraftment, development of acute graft-versus-host disease, length of stay, and overall survival. Patient-related risk factors for hyperglycemia included older age, preexisting diabetes, and insulin resistance (i.e., prediabetes). Patients of normal weight experiencing hyperglycemia had worse outcomes than patients who were overweight or obese. Treatment-related risk factors for hyperglycemia include dose and duration of immunosuppressants, specifically corticosteroids, treatment with antihyperglycemic medications, and use of total parenteral nutrition.
  
  
  CONCLUSIONS
  HCT is one of the most complex treatments for hematologic disorders. The transplantation nurse, as part of an interdisciplinary team, plays an essential role in glycemic control during the acute phase of HCT. Understanding the effects of hyperglycemia, as well as factors that place the patient at risk for hyperglycemia, allows the nurse to make well-informed, proactive interventions aimed at glycemic control.
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, City of Hope National Medical Center, Duarte, CA.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Olausson
authors.affiliation: College of Nursing, New York University in New York City.
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Hammer
authors.affiliation: Department of Endocrine Neoplasia Hormonal Disorders at MD Anderson Cancer Center, University of Texas Health Science Center.
authors.forename: Veronica
authors.initials: V
authors.lastname: Brady
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000209:etiology; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D016022:Case-Control Studies; D015984:Causality; D015331:Cohort Studies; D048909:Diabetes Complications / Q000097:blood / Q000503:physiopathology; D004198:Disease Susceptibility; D004730:Endothelium, Vascular / Q000503:physiopathology; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology; D006402:Hematologic Diseases / Q000150:complications / Q000601:surgery*; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality / Q000451:nursing / Q000706:statistics & numerical data; D006474:Hemorrhagic Disorders / Q000209:etiology; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000451:nursing / Q000503:physiopathology*; D007239:Infections / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data; D018384:Oxidative Stress; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000503:physiopathology*
chemical_list: D000305:Adrenal Cortex Hormones; D001786:Blood Glucose
keywords: hematopoietic cell transplantation; hyperglycemia; integrative review; outcomes