Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Stauber, M.
Impact of hyperglycemia on the outcome of graft-versus-host disease: a retrospective analysis
Humanmedizin; [ Diplomarbeit/Master Thesis (UNI) ] Graz Medical University; 2015. pp.68.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Wölfler Albert
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- Abstract:
- Introduction: Graft-versus-host disease (GvHD) remains one of the most severe complications after allogeneic hematopoietic stem cell tranplantation (HSCT). Since the current standard first-line treatment is based on high-dose glucocorticoid therapy, steroid-induced hyperglycemia develops frequently in patients with GvHD. However, little is known about the impact of hyperglycemia on outcome of GvHD. Methods: We performed a retrospective analysis of 102 patients who received systemic glucocorticoid therapy due to acute or chronic GvHD and investigated the impact of hyperglycemia on overall survival (OS) and transplant-related mortality (TRM) in these patients. For each subject, regular blood glucose measurements during glucocorticoid therapy were recorded. In addition, transplant- as well as GvHD-related parameters, such as underlying disease, time to onset of GvHD, number of affected organs, response to glucocorticoids, insulin therapy and (fungal)-infectious complications were obtained. For analysis, the median, mean, maximum and minimum glucose levels were taken and patients were divided into quartiles according to their glucose levels. Results: With a median of 42 (range 4-249) blood glucose measurements, 25 patients each were assigned to quartile 1 and 2 and 26 patients to quartile 3 and 4. While median OS was not reached in quartile 1, due to low numbers of death, increasing median blood glucose levels were associated with decreasing median OS of 19, 8 and 8 months for quartiles 2, 3 and 4, respectively (p = 0.0091). Similar results were obtained when mean and maximal glucose levels were used. In addition, patients who needed insulin treatment (n = 49) had a shorter median OS (8 versus 38 months, p = 0.0077). While the numbers of death due to relapse were not affected, high blood glucose values were associated with increased TRM rates. In particular, patients with invasive fungal infections (IFI) had a poor outcome (median OS of 5 months versus 24 months, p = 0.0006). In a multivariate analysis, including age at diagnosis, gender, organs affected by GvHD, BMI, donor type, HLA-matching and gender-matching, hyperglycemia remained the most prominent risk factor for short OS. Conclusion: In this retrospective analysis we observed an adverse impact of glucocorticoid-induced hyperglycemia on outcome in patients with GvDH. Prospective trials testing a stringent glycemic control are therefore urgently needed in this clinical setting.