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Abstract

Click to add/remove this article to your list of 'My Favorites' "Steroid Hyperglycemia" Is Not Benign

Year: 2009

Abstract Number: 1047-P

Authors: PANKAJ SHAH, NAIFA L. BUSAIDY, SHITIJ KAPOOR, STEVEN I. SHERMAN, VICTOR R. LAVIS

Institutions: Rochester, MN, Houston, TX

Results: To explore the clinical significance of hyperglycemia in glucocorticoid treated patients (GCC: ≥30 mg/day hydrocortisone or equivalent) we analyzed 3940 inpatients over 3 mo in a cancer center.
1628 (41.3%) of 3940 got GCC during >=1 hospitalization. GCC group was younger (53.4±17.1 vs. 57.1±16.1 yr. p<0.001), more males (54.6% vs. 47.9%, p<0.01), but similar ethnicity to the no GCC group.
Out of those tested for glucose 401(28%) of 1447 in GCC group and 237 (18%) of 1338 in no GCC group had sustained significant hyperglycemia (SSH, bld glucose [BG] ≥200 mg/dl on ≥2 days). Fewer patients with SSH received antidiabetic therapy in the GCC group than in the no GCC group (74.4% vs. 87.3%, p<0.001), but more (p <0.001) received insulin vs. oral agents. Average BG were comparable in SSH on GCC or no GCC (171.9±41.8 vs. 170.7±35.7 mg/dl), more with GCC than no GCC had ≥ 1 BG ≥300mg/dl (42.3% vs. 30.8%, OR 1.65 (95% CI 1.21-2.24)).
Within the GCC group, hyperglycemia was associated with longer hospital stay, more frequent doubling of creatinine, infections requiring IV antibiotics, and more in-hospital and long term mortality (table & figure) as compared to no SSH. Adjusted for treatment of hyperglycemia, the OR for in-hospital mortality with SSH was 2.8 (1.7-4.4) vs 1.9 (0.6-6.2) for no GCC.

Hospital stay (d)Doubling of creatinineInfectionHospital Death
No GCC No SSH6.6±6.021/1258 (1.7%)213/1325 (16.1%)27/1101 (2.5%)
No GCC SSH11.3±14.512/ 261 (4.6%)69/ 276 (25.0%)6/ 237 (2.5%)
p<0.000012.8 (1.4-5.8)^1.7 (1.3-2.4)^1.0 (0.4-2.5)^
GCC No SSH8.2±8.459/1773 (3.3%)357/1851 (19.3%)75/1046 (7.2%)
GCC SSH12.4±14.752/ 695 (7.5%)195/ 704 (27.7%)81/ 401 (20.2%)
p<0.000012.3 (1.6-3.4)^1.6 (1.3-2.0)^3.3 (2.3-4.6)^
1: out of total hospitalizations; 2:out of the last discharges; ^: OR: odds ratio SSH vs No SSHThe association of poor outcomes with hyperglycemia is at least as strong in GCC-treated patients as in those not treated with GCC.[figure1]

Category: Epidemiology

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