Glycemic variability is associated with poor outcomes in pediatric
hematopoietic stem cell transplant patients
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.