Hyperglycemia increases the complicated infection and mortality rates during induction therapy in adult acute leukemia patients

Abstract

ObjectiveTo determine the prevalence of hyperglycemia during induction therapy in adult patients with acute leukemia and its effect on complicated infections and mortality during the first 30 days of treatment. MethodsAn analysis was performed in a retrospective cohort of 280 adult patients aged 18 to 60 years with previously untreated acute leukemia who received induction chemotherapy from January 2000 to December 2009 at the Hemocentro de Pernambuco (HEMOPE), Brazil. Hyperglycemia was defined as the finding of at least one fasting glucose measurement > 100 mg/dL observed one week prior to induction therapy until 30 days after. The association between hyperglycemia and complicated infections, mortality and complete remission was evaluated using the Chi-square or Fisher's exact tests by the Statistical Package for Social Sciences (SPSS) in the R software package version 2.9.0. ResultsOne hundred and eighty-eight patients (67.1%) presented hyperglycemia at some moment during induction therapy. Eighty-two patients (29.3%) developed complicated infections. Infection-related mortality during the neutropenia period was 20.7% (58 patients). Mortality from other causes during the first 30 days after induction was 2.8%. Hyperglycemia increased the risk of complicated infections (OR 3.97; 95% confidence interval: 2.08 - 7.57; p-value < 0.001) and death (OR 3.55; 95% confidence interval: 1.77-7.12; p-value < 0.001) but did not increase the risk of fungal infections or decrease the probability of achieving complete remission. ConclusionThis study demonstrates an association between the presence of hyperglycemia and the development of complicated infections and death in adult patients during induction therapy for acute leukemia.

Prevalence and impact of hyperglycemia on hospitalized leukemia patients

“…Ali et al (2007) evaluated all hospital admissions of Acute Myeloid Leukemia (AML) patients (induction, post-remission consolidation, and relapse) and noted that 56% had at least one elevated blood glucose during hospitalization. Similarly, Matias et al (2013) studied patients with ALL and AML during induction therapy and noted that 67% experienced hyperglycemia. Overall, the current study and others elucidate a comparable and deleterious trend towards hyperglycemia in hospitalized leukemia patients similar to that of the critical care patient population (Swanson et al, 2011).…”

“…In that study, hyperglycemia (defined as 2 glucose tests 200 mg/dL) was not significantly linked to prolonged neutropenia but was linked to an increase in infection. All three of these studies suggest that hyperglycemia may play a role in infection and mortality in the patient with leukemia (Weiser et al, 2004;Ali et al, 2007;Matias et al, 2013). None of the three studies examined the impact of hyperglycemia on HLOS.…”

“…Hammer et al (2009) found that 99% (1167/1175) of bone marrow transplant (BMT) patients, including patients with leukemia, had a blood glucose 150 mg/dL during their hospitalization. Only three studies have examined the prevalence of hyperglycemia in leukemia patients, demonstrating that 37e67% of patients incurred hyperglycemia during hospitalization (Weiser et al, 2004;Ali et al, 2007;Matias et al, 2013). Taken together, these studies indicate that hyperglycemia may be a common yet under recognized problem among hospitalized patients with leukemia.…”

“…Subsequently ten additional studies have examined hyperglycemia on at least one of these clinical outcomes (Gebremedhin et al, 2012;Griffith et al, 2011;Jackson et al, 2012;Karnchanasorn et al, 2012;Matias et al, 2013;Pidala et al, 2011;Rentschler et al, 2010;Sheean et al, 2013;Soysal et al, 2012;Villareal-Garza et al, 2012). However, these studies are limited as 12/21 (57%) focused predominately on the BMT population.…”

Acute Renal and Hepatic Failure and Abnormal Blood Cell Count in Acute Leukemia: A Report of Four Cases and Review of the Literature

“…Association between the presence of hyperglycemia and the development of complicated infections and death in adult patients during induction therapy for acute leukemia [13].…”