The incidence of hyperglycemia in hematopoietic stem cell transplant recipients receiving total parenteral nutrition: A pilot study

Objective To determine whether total parenteral nutrition (TPN)-induced hyperglycemia is associated with adverse clinical outcomes. Design A retrospective cohort investigation comparing the medical records of hematopoietic stem cell transplant patients was conducted to determine clinical differences between those who received TPN and those who did not receive TPN during transplant. Subjects/Setting Forty-eight adult patients (greater than or equal to18 years) undergoing initial autologous or allogeneic hematopoietic stem cell transplant at two urban university-affiliated hospitals were eligible for inclusion. Main Outcome Measures Hyperglycemia (glucose greater than or equal to6.1 mmol/L or 110 mg/dL), presence of infection, infection duration, and in-hospital mortality. Statistical Analyses Performed chi(2), Student t, and Wilcoxon rank-sum tests were used to detect differences among the study participants. Results Patients had similar baseline demographic and clinical characteristics, with 63% receiving TPN during transplant. When standardized for time, TPN recipients at both institutions experienced significantly more hyperglycemia (P < .05) after TPN initiation. TPN patients also experienced 69% of all infections and 100% of repeat positive cultures. Additionally, significantly greater differences for TPN recipients were found for length of stay and daily charges than those who did not receive TPN. No differences were found for in-hospital mortality. Conclusions TPN is strongly associated with hyperglycemia, which may be linked to increased infections of longer duration in a profoundly immunocompromised group of patients who frequently receive TPN. The implications of these findings are limited by the small number of subjects; a larger investigation is warranted.