loading page

Glycemic variability is associated with poor outcomes in pediatric hematopoietic stem cell transplant patients
  • +5
  • Jenna Sopfe,
  • Kristen Campbell,
  • AMY Keating,
  • Laura Pyle,
  • Arthur Liu,
  • Michael Verneris,
  • Roger Giller,
  • Gregory Forlenza
Jenna Sopfe
University of Colorado Denver School of Medicine
Author Profile
Kristen Campbell
University of Colorado Denver School of Medicine
Author Profile
AMY Keating
University of Colorado Denver School of Medicine
Author Profile
Laura Pyle
University of Colorado Denver School of Medicine
Author Profile
Arthur Liu
University of Colorado Denver School of Medicine
Author Profile
Michael Verneris
University of Colorado Denver School of Medicine
Author Profile
Roger Giller
University of Colorado Denver School of Medicine
Author Profile
Gregory Forlenza
University of Colorado Denver School of Medicine
Author Profile

Abstract

Background: Among pediatric hematopoietic stem cell transplant (HSCT) recipients, abnormal glycemic control is shown to be associated with increased risk of transplant-related mortality, death from any cause, risk of infection, increased hospitalized and intensive care days. Independent effects of higher glycemic variability, a component of glycemic control, have not been described. This study aimed to characterize risk factors for, and consequences of, higher glycemic variability in HSCT patients. Procedure: Medical records for a cohort of 344 patients, age 0-30 years, who underwent first HSCT from 2007–2016 at Children’s Hospital Colorado were retrospectively reviewed. Glucose coefficients of variation (CV) were analyzed for HSCT days -14 to 0 and 0-30, and patients were assessed for potential risk factors and outcomes. Results: Roughly one third of patients had pre-HSCT and day 0-30 glucose CV above the reported healthy adult range. Independent of HSCT type, doubling of pre-HSCT glucose CV was associated with a 4.91-fold (95% CI 1.40-17.24) increased hazard of infection, as well as increased risk for intensive care hospitalization for allogenic HSCT patients. Multivariable analysis demonstrated that allogeneic HSCT patients had a 1.40- and 1.38-fold (95% CI 0.98-1.99 and 1.00-1.91) increased hazard of death for every doubling of pre-HSCT and Day 0-30 glucose CV, respectively. Conclusions: Just as with higher mean glucose, higher glycemic variability in the pediatric HSCT population is independently associated with significantly increased morbidity. Additional research is required to evaluate the utility of glucose control to mitigate these relationships and improve HSCT outcomes.

Peer review status:Published

11 May 2020Submitted to Pediatric Blood & Cancer
11 May 2020Submission Checks Completed
11 May 2020Assigned to Editor
16 May 2020Reviewer(s) Assigned
11 Jun 2020Review(s) Completed, Editorial Evaluation Pending
13 Jun 2020Editorial Decision: Revise Minor
19 Jun 20201st Revision Received
19 Jun 2020Submission Checks Completed
19 Jun 2020Assigned to Editor
24 Jun 2020Reviewer(s) Assigned
14 Jul 2020Review(s) Completed, Editorial Evaluation Pending
16 Jul 2020Editorial Decision: Accept
16 Aug 2020Published in Pediatric Blood & Cancer. 10.1002/pbc.28626