Hyperglycemia in stem cell transplant recipients: A modifiable risk factor for infection

Abstract

9605 Background: Hyperglycemia in critically ill patients is associated with increased mortality, organ dysfunction, and number of blood-borne infections. The catabolic effects of chemotherapy and the use of steroids in stem cell transplant recipients increase the likelihood of hyperglycemia. However, the effects of hyperglycemia in this patient population are unknown. Thus, we hypothesized that hyperglycemia increases the incidence of documented infections during the peri-transplant period. Methods: We conducted a retrospective review of the incidence of hyperglycemia with respect to documented infections in all patients who were admitted to our institution for an initial stem cell transplant over a 3 month period. Exclusion criteria included outpatient and subsequent transplants. Glucose data consisted of serum levels and bedside testing levels from admission to discharge. Valid infections included blood-borne infections, line-associated infections, sputum/bronchial infections (excluding normal flora or yeast), and urinary tract infections occurring during admission. Results: Patient characteristics: 59 males and 51 females, median age of 49 (range: 18–72). Disease types: AML 35, Multiple Myeloma 21, Non-Hodgkin’s Lymphoma 21, Hodgkin’s Lymphoma 11, ALL 7, CLL 6, CML 5, and others, totaling 110 patients. Forty patients (36.4%) met American Diabetes Association criteria for diabetes mellitus (DM) during admission. Forty-three patients (39.1%) developed a valid infection during admission. A majority of patients meeting DM criteria (52.5%) developed a valid infection during admission versus 31.4% of those not meeting DM criteria (p=0.02). Twenty-three patients developed acute graft-versus-host disease (GVHD) (23.6%) for which 22 of these patients received steroid therapy. The incidence of infections of those with GVHD was significantly higher than in those without GVHD (57.7% vs 34.5%, p=0.035). Conclusions: With respect to risk of infection, hyperglycemia poses significant risk to patients undergoing stem cell transplantation. Steroid therapy in the setting of GVHD is associated with a significant increase in the risk of infection. Hyperglycemia demands aggressive management to reduce the incidence of infections during the peri-transplant period. No significant financial relationships to disclose.