title: Glycemic Status and Infection Risk in Nondiabetic Autologous Hematopoietic Cell Transplantation Recipients.
abstract: 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.
authors.affiliation: New York University College of Nursing, New York, NY, USA marilyn.hammer@nyu.edu.
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Hammer
authors.affiliation: New York University College of Nursing, New York, NY, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: D'Eramo Melkus
authors.affiliation: Division of Acute Care/Health Systems, Yale University School of Nursing, New Haven, CT, USA.
authors.forename: M Tish
authors.initials: MT
authors.lastname: Knobf
authors.affiliation: Fred Hutchinson Cancer Research Center/University of Washington, Seattle, WA, USA.
authors.forename: Corey
authors.initials: C
authors.lastname: Casper
authors.affiliation: New York University College of Nursing, New York, NY, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Fletcher
authors.affiliation: New York University College of Nursing, New York, NY, USA.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Cleland
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D006402:Hematologic Diseases / Q000150:complications / Q000601:surgery*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000209:etiology*; D007239:Infections / Q000097:blood / Q000209:etiology*; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose
keywords: autologous hematopoietic cell transplantation; glycemic status; infections