Evaluation of transient hyperglycemia in non-diabetic patients with febrile neutropenia

Abstract 

Background

We aimed to examine the effect of transient hyperglycemia in non-diabetic patients with febrile neutropenia.

Methods

A total of 86 patients with febrile neutropenia were evaluated between June 2006 and December 2009. After measuring random blood glucose level at admission, cases with stress hyperglycemia were included in the study. Stress hyperglycemia was defined as documented random blood glucose level of 140mg/dl and above without known diabetes mellitus, impaired glucose tolerance and impaired fasting glucose. A Multinational Association for Supportive Care in Cancer (MASCC) scoring system was used for the prediction of low and high risk patients according to medical complications at the onset of the febrile episode.

Results

There were more patients with stress hyperglycemia than the patients with normoglycemia in the high risk group (p=0.001). The growth of gram negative bacteria and fungi was higher in patients with stress hyperglycemia than with normoglycemia (p=0.001). The patients receiving antifungal therapy had a higher rate of stress hyperglycemia than the patients without receiving antifungal therapy (p=0.009). The patients with stress hyperglycemia had higher mortality rates than the patients with normoglycemia (p=0.007). According to the MASCC risk-index, stress hyperglycemia increased 3.35 fold in the high risk patients compared to the low risk patients (p=0.046) and 4.14 fold in the patients treated with antibacterial and antifungal agents compared to the patients treated with only antibacterial agents (p=0.038).

Conclusion

Patients with stress hyperglycemia had more adverse clinical outcomes than patients with normoglycemia. We think further studies are needed to evaluate the relationship between stress hyperglycemia and febrile neutropenia.

Keywords: Febrile neutropenia, MASCC risk-index, Stress hyperglycemia