Stress-induced hyperglycemia is a valuable biomarker in febrile neutropenia

Carmona-Bayonas, Alberto; Font, Carme; Peña, Francisco Ayala de la

doi:10.5581/1516-8484.20130006

Cited by 3 publications

(1 citation statement)

References 24 publications

(19 reference statements)

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“…Acute stress, critical illness, and the direct effect of certain chemotherapeutic agents used during the induction phase have been shown to increase blood glucose concentrations. [1][2][3][4][5][6][12][13][14][15][16][17][18] In addition, certain patient character- risk of hyperglycemia with many of these characteristics, though no previous work has comprehensively evaluated all within the same cohort. 1,4,[6][7][8][9][10][11]19 Although modeling results did identify an association between prednisone use and increased odds of hyperglycemia on univariate analysis, this relationship was not significant on multivariate analysis.…”

Section: Resultsmentioning

confidence: 99%

Hyperglycemia requiring insulin during acute lymphoblastic leukemia induction chemotherapy is associated with increased adverse outcomes and healthcare costs

McCormick

Sharp

Kalpatthi

et al. 2020

Pediatric Blood & Cancer

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Background Hyperglycemia is a complication of induction chemotherapy in 10%‐50% of pediatric patients with acute lymphoblastic leukemia (ALL). Though hyperglycemia in ALL patients is usually transient, it may be associated with adverse health outcomes. However, the risk factors for and consequences of hyperglycemia are poorly understood. We hypothesized that hyperglycemia significant enough to require insulin therapy during induction chemotherapy would be associated with increased morbidity and mortality in pediatric ALL patients during induction chemotherapy and in subsequent care. Methods We abstracted clinical and resource utilization data from the Pediatric Health Information System (PHIS) database utilizing ICD‐9 codes and medication charges. We used logistic regression analysis to predict the development of hyperglycemia. The effects of hyperglycemia on binary and count adverse outcomes following induction chemotherapy were modeled using mixed‐effect regression models. Results An increased risk of hyperglycemia requiring insulin was associated with older age, female sex, higher risk group and trisomy 21. Patients on insulin for hyperglycemia had increased mortality following induction chemotherapy. These patients were more likely to have subsequent infectious complications, need for bone marrow transplant, and risk of disease relapse. They also had greater length of inpatient stay, higher cost of care, and were more likely to require intensive care unit admission during induction chemotherapy. Conclusions Hyperglycemia requiring insulin during induction chemotherapy in pediatric ALL is associated with an increased risk of short‐term and long‐term complications. Prospective studies are needed to analyze formal screening, preventive measures, and optimal management practices for hyperglycemia during ALL induction chemotherapy.

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Section: Resultsmentioning

confidence: 99%

Hyperglycemia requiring insulin during acute lymphoblastic leukemia induction chemotherapy is associated with increased adverse outcomes and healthcare costs

McCormick

Sharp

Kalpatthi

et al. 2020

Pediatric Blood & Cancer

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The time has come for new models in febrile neutropenia: a practical demonstration of the inadequacy of the MASCC score

et al. 2017

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Since its publication more than 15 years ago, the MASCC score has been internationally validated any number of times and recommended by most clinical practice guidelines for the management of febrile neutropenia (FN) around the world. We have used an empirical data-supported simulated scenario to demonstrate that, despite everything, the MASCC score is impractical as a basis for decision-making. A detailed analysis of reasons supporting the clinical irrelevance of this model is performed. First, seven of its eight variables are "innocent bystanders" that contribute little to selecting low-risk candidates for ambulatory management. Secondly, the training series was hardly representative of outpatients with solid tumors and low-risk FN. Finally, the simultaneous inclusion of key variables both in the model and in the outcome explains its successful validation in various series of patients. Alternative methods of prognostic classification, such as the Clinical Index of Stable Febrile Neutropenia, have been specifically validated for patients with solid tumors and should replace the MASCC model in situations of clinical uncertainty.

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