{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T00:41:55Z","timestamp":1784335315006,"version":"3.55.0"},"reference-count":23,"publisher":"American Diabetes Association","issue":"10","content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2008,10,1]]},"abstract":"<jats:p>OBJECTIVE\u2014To use bone marrow transplantation (BMT) as a model for testing the association between hyperglycemia and infection.<\/jats:p>\n               <jats:p>RESEARCH DESIGN AND METHODS\u2014This cohort study included 382 adults (6.5% with diabetes) who had no evidence of infection before neutropenia during BMT. Mean glucose was calculated from central laboratory and bedside measurements taken before neutropenia; the primary outcome was neutropenic infections.<\/jats:p>\n               <jats:p>RESULTS\u2014Eighty-four patients (22%) developed at least one neutropenic infection, including 51 patients (13%) with bloodstream infections. In patients who did not receive glucocorticoids during neutropenia, each 10 mg\/dl increase in mean preneutropenia glucose was associated with an odds ratio of 1.08 (95% CI 0.98\u20131.19) (P = 0.14) for any infection and 1.15 (1.03\u20131.28) (P = 0.01) for bloodstream infections, after adjusting for age, sex, race, year, cancer diagnosis, transplant type, and total glucocorticoid dose before neutropenia. In those who received glucocorticoids during neutropenia (n = 71), the adjusted odds ratio associated with a 10 mg\/dl increase in mean glucose was 1.21 (1.09\u20131.34) (P &amp;lt; 0.0001) for any infection and 1.24 (1.11\u20131.38) (P &amp;lt; 0.0001) for bloodstream infections. There was no association between mean glycemia and long length of hospital stay, critical status designation, or mortality.<\/jats:p>\n               <jats:p>CONCLUSIONS\u2014In a BMT population highly susceptible to infection, there was a continuous positive association between mean antecedent glycemia and later infection risk, particularly in patients who received glucocorticoids while neutropenic. Tight glycemic control during BMT and glucocorticoid treatment may reduce infections.<\/jats:p>","DOI":"10.2337\/dc08-0574","type":"journal-article","created":{"date-parts":[[2008,7,24]],"date-time":"2008-07-24T01:01:05Z","timestamp":1216861265000},"page":"1972-1977","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":52,"title":["Antecedent Hyperglycemia Is Associated With an Increased Risk of Neutropenic Infections During Bone Marrow Transplantation"],"prefix":"10.2337","volume":"31","author":[{"given":"Rachel L.","family":"Derr","sequence":"first","affiliation":[{"name":"Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland"},{"name":"Division of Endocrinology and Metabolism, Johns Hopkins Medical Institutions, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria C.","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher D.","family":"Saudek","sequence":"additional","affiliation":[{"name":"Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland"},{"name":"Division of Endocrinology and Metabolism, Johns Hopkins Medical Institutions, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","reference":[{"key":"2022031216170107500_R1","doi-asserted-by":"crossref","unstructured":"Weiser MA, Cabanillas ME, Konopleva M, Thomas DA, Pierce SA, Escalante CP, Kantarjian HM, O'Brien SM: Relation between the duration of remission and hyperglycemia during induction chemotherapy for acute lymphocytic leukemia with a hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone\/methotrexate-cytarabine regimen. Cancer\u2008100: 1179\u20131185, 2004","DOI":"10.1002\/cncr.20071"},{"key":"2022031216170107500_R2","doi-asserted-by":"crossref","unstructured":"Golden SH, Peart-Vigilance C, Kao WH, Brancati FL: Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care\u200822:1408\u20131414, 1999","DOI":"10.2337\/diacare.22.9.1408"},{"key":"2022031216170107500_R3","doi-asserted-by":"crossref","unstructured":"Baker EH, Jana way CH, Philips BJ, Brennan AL, Baines DL, Wood DM, Jones PW: Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease. Thorax\u200861:284\u2013289, 2006","DOI":"10.1136\/thx.2005.051029"},{"key":"2022031216170107500_R4","doi-asserted-by":"crossref","unstructured":"Sung J, Bochicchio GV, Joshi M, Bochicchio K, Tracy K, Scalea TM: Admission hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma\u200859:80\u201383, 2005","DOI":"10.1097\/01.TA.0000171452.96585.84"},{"key":"2022031216170107500_R5","doi-asserted-by":"crossref","unstructured":"Sayer HG, Longton G, Bowden R, Pepe M, Storb R: Increased risk of infection in marrow transplant patients receiving methylprednisolone for graft-versus-host disease prevention. Blood\u200884:1328\u20131332, 1994","DOI":"10.1182\/blood.V84.4.1328.1328"},{"key":"2022031216170107500_R6","doi-asserted-by":"crossref","unstructured":"Benfield T, Jensen JS, Nordestgaard BG: Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome. Diabetologia\u200850:549\u2013554, 2007","DOI":"10.1007\/s00125-006-0570-3"},{"key":"2022031216170107500_R7","doi-asserted-by":"crossref","unstructured":"Thomsen RW, Hundborg HH, Lervang HH, Johnsen SP, Schonheyder HC, Sorensen HT: Risk of community-acquired pneumococcal bacteremia in patients with diabetes: a population-based case-control study. Diabetes Care\u200827:1143\u20131147, 2004","DOI":"10.2337\/diacare.27.5.1143"},{"key":"2022031216170107500_R8","doi-asserted-by":"crossref","unstructured":"Muller LM, Gorter KJ, Hak E, Goudzwaard WL, Schellevis FG, Hoepelman AI, Rutten GE: Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis\u200841:281\u2013288, 2005","DOI":"10.1086\/431587"},{"key":"2022031216170107500_R9","doi-asserted-by":"crossref","unstructured":"Turina M, Fry DE, Polk HC Jr: Acute hyperglycemia and the innate immune system: clinical, cellular, and molecular aspects. Crit Care Med\u200833:1624\u20131633, 2005","DOI":"10.1097\/01.CCM.0000170106.61978.D8"},{"key":"2022031216170107500_R10","doi-asserted-by":"crossref","unstructured":"Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B: Impaired leucocyte functions in diabetic patients. Diabet Med\u200814:29\u201334, 1997","DOI":"10.1002\/(SICI)1096-9136(199701)14:1<29::AID-DIA300>3.0.CO;2-V"},{"key":"2022031216170107500_R11","doi-asserted-by":"crossref","unstructured":"Otton R, Soriano FG, Verlengia R, Curi R: Diabetes induces apoptosis in lymphocytes. J Endocrinol\u2008182:145\u2013156, 2004","DOI":"10.1677\/joe.0.1820145"},{"key":"2022031216170107500_R12","doi-asserted-by":"crossref","unstructured":"Sakowicz-Burkiewicz M, Kocbuch K, Grden M, Szutowicz A, Pawelczyk T: Diabetes-induced decrease of adenosine kinase expression impairs the proliferation potential of diabetic rat T lymphocytes. Immunology\u2008118:402\u2013412, 2006","DOI":"10.1111\/j.1365-2567.2006.02380.x"},{"key":"2022031216170107500_R13","doi-asserted-by":"crossref","unstructured":"Hostetter MK: Handicaps to host defense: effects of hyperglycemia on C3 and candida albicans. Diabetes\u200839:271\u2013275, 1990","DOI":"10.2337\/diabetes.39.3.271"},{"key":"2022031216170107500_R14","doi-asserted-by":"crossref","unstructured":"Black CT, Hennessey PJ, Andrassy RJ: Short-term hyperglycemia depresses immunity through nonenzymatic glycosylation of circulating immunoglobulin. J Trauma\u200830:830\u2013832, 1990 [discussion\u200830:832\u2013833]","DOI":"10.1097\/00005373-199007000-00012"},{"key":"2022031216170107500_R15","doi-asserted-by":"crossref","unstructured":"Philips BJ, Redman J, Brennan A, Wood D, Holliman R, Baines D, Baker EH: Glucose in bronchial aspirates increases the risk of respiratory MRSA in intubated patients. Thorax\u200860:761\u2013764, 2005","DOI":"10.1136\/thx.2004.035766"},{"key":"2022031216170107500_R16","doi-asserted-by":"crossref","unstructured":"Fuji S, Kim SW, Mori S, Fukuda T, Kamiya S, Yamasaki S, Morita-Hoshi Y, Ohara-Waki F, Honda O, Kuwahara S, Tanosaki R, Heike Y, Tobinai K, Takaue Y: Hyperglycemia during the neutropenic period is associated with a poor outcome in patients undergoing myeloablative allogeneic hematopoietic stem cell transplantation. Transplantation\u200884:814\u2013820, 2007","DOI":"10.1097\/01.tp.0000296482.50994.1c"},{"key":"2022031216170107500_R17","doi-asserted-by":"crossref","unstructured":"Sheean PM, Freels SA, Helton WS, Braunschweig CA: Adverse clinical consequences of hyperglycemia from total parenteral nutrition exposure during hematopoietic stem cell transplantation. Biol Blood Marrow Transplant\u200812:656\u2013664, 2006","DOI":"10.1016\/j.bbmt.2006.01.010"},{"key":"2022031216170107500_R18","doi-asserted-by":"crossref","unstructured":"Garg R, Bhutani H, Alyea E, Pendergrass M: Hyperglycemia and length of stay in patients hospitalized for bone marrow transplantation. Diabetes Care\u200830:993\u2013994, 2007","DOI":"10.2337\/dc06-2563"},{"key":"2022031216170107500_R19","doi-asserted-by":"crossref","unstructured":"Stuck AE, Minder CE, Frey FJ: Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis\u200811:954\u2013963, 1989","DOI":"10.1093\/clinids\/11.6.954"},{"key":"2022031216170107500_R20","doi-asserted-by":"crossref","unstructured":"Lew MA, Kehoe K, Ritz J, Antman KH, Nadler L, Kalish LA, Finberg R: Ciprofloxacin versus trimethoprim\/sulfamethoxazole for prophylaxis of bacterial infections in bone marrow transplant recipients: a randomized, controlled trial. J Clin Oncol\u200813:239\u2013250, 1995","DOI":"10.1200\/JCO.1995.13.1.239"},{"key":"2022031216170107500_R21","doi-asserted-by":"crossref","unstructured":"Goodman JL, Winston DJ, Greenfield RA, Chandrasekar PH, Fox B, Kaizer H, Shadduck RK, Shea TC, Stiff P, Friedman DJ: A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med\u2008326:845\u2013851, 1992","DOI":"10.1056\/NEJM199203263261301"},{"key":"2022031216170107500_R22","doi-asserted-by":"crossref","unstructured":"Passweg JR, Rowlings PA, Atkinson KA, Barrett AJ, Gale RP, Gratwohl A, Jacobsen N, Klein JP, Ljungman P, Russell JA, Schaefer UW, Sobocinski KA, Vossen JM, Zhang MJ, Horowitz MM: Influence of protective isolation on outcome of allogeneic bone marrow transplantation for leukemia. Bone Marrow Transplant\u200821:1231-1238, 1998","DOI":"10.1038\/sj.bmt.1701238"},{"key":"2022031216170107500_R23","doi-asserted-by":"crossref","unstructured":"Sherertz RJ, Belani A, Kramer BS, Elfenbein GJ, Weiner RS, Sullivan ML, Thomas RG, Samsa GP: Impact of air filtration on nosocomial aspergillus infections. unique risk of bone marrow transplant recipients. Am J Med\u200883:709\u2013718, 1987","DOI":"10.1016\/0002-9343(87)90902-8"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/31\/10\/1972\/598381\/zdc01008001972.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/31\/10\/1972\/598381\/zdc01008001972.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,12]],"date-time":"2022-03-12T16:41:10Z","timestamp":1647103270000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/31\/10\/1972\/25043\/Antecedent-Hyperglycemia-Is-Associated-With-an"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,10,1]]},"references-count":23,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2008,10,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc08-0574","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,10,1]]}}}