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.

Research Design and Methods: This cohort study included 382 adults (6.5% with diabetes) who had no evidence of infection prior to 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 pre-neutropenia glucose was associated with an OR of 1.08 [95% CI: 0.98 - 1.19, p = 0.14] for any infection and 1.15 [95% CI: 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 OR associated with a 10 mg/dl increase in mean glucose was 1.21 [95%CI: 1.09 – 1.34, p < 0.0001] for any infection and 1.24 [95% CI: 1.11 – 1.38, p < 0.0001] for bloodstream infections. There was no association between mean glycemia and long hospital length of 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.