Glycemic variability is associated with poor outcomes in pediatric hematopoietic stem cell transplant patients
Jenna Sopfe1, Kristen Campbell2, Amy K Keating1
1Bone Marrow Transplant Program, Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Colorado.
Insights
Higher glycemic variability in pediatric hematopoietic stem cell transplant (HSCT) patients is linked to increased infection and death risks. Managing glucose variability may improve outcomes for these vulnerable children.
Area of Science:
- Pediatric Hematology
- Endocrinology
- Transplant Medicine
Background:
- Abnormal glycemic control increases risks in pediatric hematopoietic stem cell transplant (HSCT) recipients, including mortality and infection.
- The independent impact of glycemic variability, a key aspect of glucose control, on HSCT outcomes remains understudied.
Purpose of the Study:
- To investigate risk factors contributing to higher glycemic variability in pediatric HSCT patients.
- To determine the consequences of elevated glycemic variability on morbidity and mortality in this population.
Main Methods:
- Retrospective review of 344 pediatric HSCT patients (age 0-30 years) from 2007-2016.
- Analysis of glucose coefficients of variation (CV) during pre-HSCT and post-HSCT periods.
- Assessment of potential risk factors and clinical outcomes, including infection and hospitalization.
Main Results:
- Approximately one-third of patients exhibited glucose CV above healthy adult ranges before HSCT and in the early post-transplant period.
- Increased pre-HSCT glucose CV independently elevated the hazard of infection and intensive care hospitalization.
- Higher pre-HSCT and post-HSCT glucose CV were associated with an increased hazard of death in allogeneic HSCT recipients.
Conclusions:
- Elevated glycemic variability, similar to high mean glucose, is independently associated with increased morbidity in pediatric HSCT patients.
- Further research is needed to explore glucose control strategies for mitigating risks and improving HSCT outcomes.
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 to 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% confidence interval [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.
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