Impact of Hyperglycemia and Diabetes Mellitus on Breakthrough Mucormycosis Outcomes in Patients with Hematologic Malignancies—Complex and Intriguing Associations
Mucormycosis (MCR) is frequently associated with diabetic ketoacidosis and hyperglycemia, as well as hematologic malignancies (HMs) and hematopoietic stem cell transplantation (HSCT). However, little is known about the effect of hyperglycemia on MCR outcomes in patients with HMs. We therefore conduc...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-12-01
|
| Series: | Journal of Fungi |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2309-608X/9/1/45 |
| _version_ | 1797440228469768192 |
|---|---|
| author | Alexander Franklin Sebastian Wurster Dierdre B. Axell-House Ying Jiang Dimitrios P. Kontoyiannis |
| author_facet | Alexander Franklin Sebastian Wurster Dierdre B. Axell-House Ying Jiang Dimitrios P. Kontoyiannis |
| author_sort | Alexander Franklin |
| collection | DOAJ |
| description | Mucormycosis (MCR) is frequently associated with diabetic ketoacidosis and hyperglycemia, as well as hematologic malignancies (HMs) and hematopoietic stem cell transplantation (HSCT). However, little is known about the effect of hyperglycemia on MCR outcomes in patients with HMs. We therefore conducted a retrospective cohort study of adult patients hospitalized with MCR and HM or HSCT (<i>n</i> = 103) at MD Anderson Cancer Center from April 2000 through to April 2020. Twenty-three patients (22%) had documented episodes of severe hyperglycemia. Sixty patients had >5 serum glucose measurements within 28 days prior to MCR symptom onset; of those, 14 (23%) met the criteria for persistent hyperglycemia. Sixteen patients (16%) received insulin prior to admission. The crude mortality 42 days from the onset of MCR symptoms in our cohort was 31%. Neither severe nor persistent hyperglycemia were associated with excess mortality. Insulin use prior to index admission was associated with decreased 42-day mortality on univariate analysis (<i>p</i> = 0.031). In conclusion, in a setting of high crude mortality, severe and/or persistent hyperglycemia do not appear to be associated with excess mortality in patients with HM or HSCT developing MCR. Insulin use prior to MCR diagnosis may be associated with decreased mortality, although further research is needed to validate this effect and to study its mechanistic underpinnings. |
| first_indexed | 2024-03-09T12:05:08Z |
| format | Article |
| id | doaj.art-d476db5278144d9b9ef111d5dc075090 |
| institution | Directory Open Access Journal |
| issn | 2309-608X |
| language | English |
| last_indexed | 2024-03-09T12:05:08Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Fungi |
| spelling | doaj.art-d476db5278144d9b9ef111d5dc0750902023-11-30T22:59:34ZengMDPI AGJournal of Fungi2309-608X2022-12-01914510.3390/jof9010045Impact of Hyperglycemia and Diabetes Mellitus on Breakthrough Mucormycosis Outcomes in Patients with Hematologic Malignancies—Complex and Intriguing AssociationsAlexander Franklin0Sebastian Wurster1Dierdre B. Axell-House2Ying Jiang3Dimitrios P. Kontoyiannis4Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADivision of Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston, TX 77030, USADepartment of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USAMucormycosis (MCR) is frequently associated with diabetic ketoacidosis and hyperglycemia, as well as hematologic malignancies (HMs) and hematopoietic stem cell transplantation (HSCT). However, little is known about the effect of hyperglycemia on MCR outcomes in patients with HMs. We therefore conducted a retrospective cohort study of adult patients hospitalized with MCR and HM or HSCT (<i>n</i> = 103) at MD Anderson Cancer Center from April 2000 through to April 2020. Twenty-three patients (22%) had documented episodes of severe hyperglycemia. Sixty patients had >5 serum glucose measurements within 28 days prior to MCR symptom onset; of those, 14 (23%) met the criteria for persistent hyperglycemia. Sixteen patients (16%) received insulin prior to admission. The crude mortality 42 days from the onset of MCR symptoms in our cohort was 31%. Neither severe nor persistent hyperglycemia were associated with excess mortality. Insulin use prior to index admission was associated with decreased 42-day mortality on univariate analysis (<i>p</i> = 0.031). In conclusion, in a setting of high crude mortality, severe and/or persistent hyperglycemia do not appear to be associated with excess mortality in patients with HM or HSCT developing MCR. Insulin use prior to MCR diagnosis may be associated with decreased mortality, although further research is needed to validate this effect and to study its mechanistic underpinnings.https://www.mdpi.com/2309-608X/9/1/45mucormycosishematologic malignancydiabetes mellitushyperglycemiainsulinmortality |
| spellingShingle | Alexander Franklin Sebastian Wurster Dierdre B. Axell-House Ying Jiang Dimitrios P. Kontoyiannis Impact of Hyperglycemia and Diabetes Mellitus on Breakthrough Mucormycosis Outcomes in Patients with Hematologic Malignancies—Complex and Intriguing Associations Journal of Fungi mucormycosis hematologic malignancy diabetes mellitus hyperglycemia insulin mortality |
| title | Impact of Hyperglycemia and Diabetes Mellitus on Breakthrough Mucormycosis Outcomes in Patients with Hematologic Malignancies—Complex and Intriguing Associations |
| title_full | Impact of Hyperglycemia and Diabetes Mellitus on Breakthrough Mucormycosis Outcomes in Patients with Hematologic Malignancies—Complex and Intriguing Associations |
| title_fullStr | Impact of Hyperglycemia and Diabetes Mellitus on Breakthrough Mucormycosis Outcomes in Patients with Hematologic Malignancies—Complex and Intriguing Associations |
| title_full_unstemmed | Impact of Hyperglycemia and Diabetes Mellitus on Breakthrough Mucormycosis Outcomes in Patients with Hematologic Malignancies—Complex and Intriguing Associations |
| title_short | Impact of Hyperglycemia and Diabetes Mellitus on Breakthrough Mucormycosis Outcomes in Patients with Hematologic Malignancies—Complex and Intriguing Associations |
| title_sort | impact of hyperglycemia and diabetes mellitus on breakthrough mucormycosis outcomes in patients with hematologic malignancies complex and intriguing associations |
| topic | mucormycosis hematologic malignancy diabetes mellitus hyperglycemia insulin mortality |
| url | https://www.mdpi.com/2309-608X/9/1/45 |
| work_keys_str_mv | AT alexanderfranklin impactofhyperglycemiaanddiabetesmellitusonbreakthroughmucormycosisoutcomesinpatientswithhematologicmalignanciescomplexandintriguingassociations AT sebastianwurster impactofhyperglycemiaanddiabetesmellitusonbreakthroughmucormycosisoutcomesinpatientswithhematologicmalignanciescomplexandintriguingassociations AT dierdrebaxellhouse impactofhyperglycemiaanddiabetesmellitusonbreakthroughmucormycosisoutcomesinpatientswithhematologicmalignanciescomplexandintriguingassociations AT yingjiang impactofhyperglycemiaanddiabetesmellitusonbreakthroughmucormycosisoutcomesinpatientswithhematologicmalignanciescomplexandintriguingassociations AT dimitriospkontoyiannis impactofhyperglycemiaanddiabetesmellitusonbreakthroughmucormycosisoutcomesinpatientswithhematologicmalignanciescomplexandintriguingassociations |