Stauber Melanie N, Aberer Felix, Oulhaj Abderrahim, Mader Julia K, Zebisch Armin, Pieber Thomas R, Neumeister Peter, Greinix Hildegard T, Sill Heinz, Sourij Harald, Wölfler Albert
Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Biol Blood Marrow Transplant. 2017 Jul;23(7):1186-1192. doi: 10.1016/j.bbmt.2017.03.010. Epub 2017 Mar 8.
Because of first-line treatment with high-dose glucocorticoids (GC), steroid-induced hyperglycemia develops frequently in patients with acute graft-versus-host disease (aGVHD), potentially affecting their outcome. We performed a retrospective analysis on 104 patients who received systemic GC for aGVHD and investigated the consequences of aberrant glucose metabolism. In particular, we focused on glucose parameters early after initiation of GC. With a median of 50 (range, 4 to 513) blood glucose measurements during GC treatment, increasing mean, median, and maximum glucose levels and the need for insulin treatment were associated with decreased overall survival (OS) in simple and multiple survival analysis. Early hyperglycemia, as defined by mean blood glucose levels >125 mg/dL during the first 3 days of GC therapy, was also found to be highly associated with adverse outcome (hazard ratio [HR], 2.5 for death; 95% confidence interval [CI], 1.3 to 4.8, and HR of 3.5 for death due to nonrelapse mortality, 95% CI, 1.7 to 7.5, in a competing risk analysis). A score based on early hyperglycemia and nonresponse to GC within 7 days allowed the identification of 3 risk groups: patients with both risk factors had an inferior OS at 5 years of 4.1% compared with 75.4% in patients with none. Patients with 1 risk factor had a 5-year OS rate of 32.0% (P = .0002 for trend). Early hyperglycemia after GC initiation is a prominent risk factor for adverse outcome in patients with aGVHD. A score based solely on early hyperglycemia and lack of response to GC can predict survival in these patients.
由于急性移植物抗宿主病（aGVHD）患者一线采用大剂量糖皮质激素（GC）治疗，类固醇诱导的高血糖症在这些患者中频繁发生，这可能会影响其治疗结果。我们对104例接受全身性GC治疗aGVHD的患者进行了回顾性分析，并研究了糖代谢异常的后果。特别是，我们关注了GC治疗开始后早期的血糖参数。在GC治疗期间，患者的血糖测量中位数为50次（范围为4至513次），在单因素和多因素生存分析中，平均、中位数和最高血糖水平的升高以及胰岛素治疗的需求与总生存期（OS）降低相关。在GC治疗的前3天，平均血糖水平>125mg/dL所定义的早期高血糖症也被发现与不良结局高度相关（风险比[HR]，死亡为2.5；95%置信区间[CI]，1.3至4.8，在竞争风险分析中，因非复发死亡率导致的死亡HR为3.5，95%CI，1.7至7.5）。基于早期高血糖症和7天内对GC无反应的评分可识别出3个风险组：有两个风险因素的患者5年总生存期较差，为4.1%，而无风险因素的患者为75.4%。有1个风险因素的患者5年总生存率为32.0%（趋势P = 0.0002）。GC治疗开始后的早期高血糖症是aGVHD患者不良结局的一个显著风险因素。仅基于早期高血糖症和对GC无反应的评分可预测这些患者的生存期。
