The Contribution of Malglycemia to Mortality among Allogeneic Hematopoietic Cell Transplant Recipients
The Contribution of Malglycemia to Mortality among Allogeneic Hematopoietic Cell Transplant Recipients
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DOI：
10.1016/j.bbmt.2008.12.488
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发表时间：
2009-03-01
影响因子：
4.3
通讯作者：
Hirsch, Irl B.
中科院分区：
文献类型：
--
作者：
Hammer, Marilyn J.;Casper, Corey;Hirsch, Irl B.
异基因造血细胞移植（HCT）仍然与非复发死亡率（NRM）的显着率。许多因素影响HCT受者的糖代谢。我们假设，“血糖异常”（定义为高血糖、低血糖或血糖变异性增加）与HCT患者死亡率增加相关。在一项回顾性队列研究中，使用考克斯回归来评估移植后的恶性肿瘤与第200天NRM的相关性。在2000年至2005年期间，对Fred哈钦森癌症研究中心的1175名成人异基因HCT接受者的66，062次血糖（BG）测量值进行了评价（中位数为0.55值/患者-天，范围：0.09-3.62）。总体而言，在HCT后第200天有215例NRM病例，在整个观察期间有601例任何原因导致的死亡。在对先前确定的与NRM相关的因素进行调整后，当单独建模为时间依赖性协变量时，所有3个组成部分的maltose均与NRM增加相关。具体而言，与BG 101-150 mg/dL相比，BG 5200 mg/dL（P = .0009）和BG 5300（P = .0004）的死亡风险比分别为1.93和2.78。最低血糖
Allogeneic hematopoietic cell transplantation (HCT) continues to be associated with substantial rates of nonrelapse mortality (NRM). Numerous factors influence glucose metabolism among HCT recipients. We hypothesized that "malglycemia," defined as hyperglycemia, hypoglycemia or increased glycemic variability, is associated with increased mortality in HCT patients. In a retrospective cohort study Cox regression was used to assess the association of malglycemia after transplant with day 200 NRM. A total of 66,062 blood glucose (BG) measurements from 1175 adult allogeneic HCT recipients between 2000 and 2005 at the Fred Hutchinson Cancer Research Center were evaluated (median 0.55 values per patient-day, range: 0.09-3.62). Overall, there were 215 cases of NRM by day 200 post-HCT and 601 deaths from any cause throughout observation. After adjustment for previously identified factors associated with NRM, all 3 components of malglycemia were associated with increased NRM when individually modeled as time-dependent covariates. Specifically, the hazard ratio for death was 1.93 for BG 5200 mg/dL (P = .0009) and 2.78 for BG 5300 (P = .0004) compared with BG 101-150 mg/dL. A minimum BG