Poor Glycemic Control Is Associated With Decreased Survival in Lung Transplant Recipients
BACKGROUNDDiabetes mellitus (DM) is associated with increased mortality after transplantation, but the effect of glycemic control on survival is unknown.We sought to determine the relationship between glycemic control (random blood glucose [RBG], fasting blood glucose [FBG], and glycated hemoglobin...
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| Veröffentlicht in: | Transplantation 2017-09, Vol.101 (9), p.2200-2206 |
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| creator | Hackman, Kathryn L Snell, Gregory I Bach, Leon A |
| description | BACKGROUNDDiabetes mellitus (DM) is associated with increased mortality after transplantation, but the effect of glycemic control on survival is unknown.We sought to determine the relationship between glycemic control (random blood glucose [RBG], fasting blood glucose [FBG], and glycated hemoglobin [HbA1c]) and survival in all lung transplant (LTx) recipients and those with either persistent or no DM.
METHODSAll 210 LTx recipients from August 1, 2010 to November 1, 2013, were included (median observation 3.0 years). All underwent oral glucose tolerance tests pre-LTx and serially post-LTx. All glucose and HbA1c results from LTx until study end were included, and hazard ratios were calculated.
RESULTSOf 210 patients, 90 had persistent DM, and 84 had no DM. Overall mortality/repeat LTx was 31%. In the whole cohort, each 1 mM (18 mg/dL) increase in mean FBG and RBG and each 1% increase in mean HbA1c were associated with mortality increases of 18% (95% confidence interval [CI], 5-32%, P = 0.006), 38% (95% CI, 15-65%; P < 0.001), and 46% (95% CI, 15-85%; P = 0.002), respectively. RBG correlated with mortality in the persistent DM and no DM groups, 37% (95% CI, 7-75%; P = 0.012) and 109% (95% CI, 3-323%; P = 0.041) increases/1 mM, respectively).
CONCLUSIONSGlycemic control strongly correlates with survival after LTx. RBG predicted mortality overall and in patients with and without DM. We propose hyperglycemia be managed promptly after LTx. |
| doi_str_mv | 10.1097/TP.0000000000001555 |
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METHODSAll 210 LTx recipients from August 1, 2010 to November 1, 2013, were included (median observation 3.0 years). All underwent oral glucose tolerance tests pre-LTx and serially post-LTx. All glucose and HbA1c results from LTx until study end were included, and hazard ratios were calculated.
RESULTSOf 210 patients, 90 had persistent DM, and 84 had no DM. Overall mortality/repeat LTx was 31%. In the whole cohort, each 1 mM (18 mg/dL) increase in mean FBG and RBG and each 1% increase in mean HbA1c were associated with mortality increases of 18% (95% confidence interval [CI], 5-32%, P = 0.006), 38% (95% CI, 15-65%; P < 0.001), and 46% (95% CI, 15-85%; P = 0.002), respectively. RBG correlated with mortality in the persistent DM and no DM groups, 37% (95% CI, 7-75%; P = 0.012) and 109% (95% CI, 3-323%; P = 0.041) increases/1 mM, respectively).
CONCLUSIONSGlycemic control strongly correlates with survival after LTx. RBG predicted mortality overall and in patients with and without DM. We propose hyperglycemia be managed promptly after LTx.</description><identifier>ISSN: 0041-1337</identifier><identifier>EISSN: 1534-6080</identifier><identifier>DOI: 10.1097/TP.0000000000001555</identifier><identifier>PMID: 27798516</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Adult ; Aged ; Biomarkers - blood ; Blood Glucose - drug effects ; Blood Glucose - metabolism ; Chi-Square Distribution ; Diabetes Mellitus - blood ; Diabetes Mellitus - diagnosis ; Diabetes Mellitus - drug therapy ; Diabetes Mellitus - mortality ; Female ; Glucose Tolerance Test ; Glycated Hemoglobin A - metabolism ; Humans ; Hypoglycemic Agents - therapeutic use ; Immunosuppressive Agents - therapeutic use ; Kaplan-Meier Estimate ; Lung Transplantation - adverse effects ; Lung Transplantation - mortality ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome ; Victoria</subject><ispartof>Transplantation, 2017-09, Vol.101 (9), p.2200-2206</ispartof><rights>Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4035-bc960a5098b565f3efa00b0ae76fc05b170a8ab4db410fdc98b54d9b03ad6df43</citedby><cites>FETCH-LOGICAL-c4035-bc960a5098b565f3efa00b0ae76fc05b170a8ab4db410fdc98b54d9b03ad6df43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27798516$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hackman, Kathryn L</creatorcontrib><creatorcontrib>Snell, Gregory I</creatorcontrib><creatorcontrib>Bach, Leon A</creatorcontrib><title>Poor Glycemic Control Is Associated With Decreased Survival in Lung Transplant Recipients</title><title>Transplantation</title><addtitle>Transplantation</addtitle><description>BACKGROUNDDiabetes mellitus (DM) is associated with increased mortality after transplantation, but the effect of glycemic control on survival is unknown.We sought to determine the relationship between glycemic control (random blood glucose [RBG], fasting blood glucose [FBG], and glycated hemoglobin [HbA1c]) and survival in all lung transplant (LTx) recipients and those with either persistent or no DM.
METHODSAll 210 LTx recipients from August 1, 2010 to November 1, 2013, were included (median observation 3.0 years). All underwent oral glucose tolerance tests pre-LTx and serially post-LTx. All glucose and HbA1c results from LTx until study end were included, and hazard ratios were calculated.
RESULTSOf 210 patients, 90 had persistent DM, and 84 had no DM. Overall mortality/repeat LTx was 31%. In the whole cohort, each 1 mM (18 mg/dL) increase in mean FBG and RBG and each 1% increase in mean HbA1c were associated with mortality increases of 18% (95% confidence interval [CI], 5-32%, P = 0.006), 38% (95% CI, 15-65%; P < 0.001), and 46% (95% CI, 15-85%; P = 0.002), respectively. RBG correlated with mortality in the persistent DM and no DM groups, 37% (95% CI, 7-75%; P = 0.012) and 109% (95% CI, 3-323%; P = 0.041) increases/1 mM, respectively).
CONCLUSIONSGlycemic control strongly correlates with survival after LTx. RBG predicted mortality overall and in patients with and without DM. We propose hyperglycemia be managed promptly after LTx.</description><subject>Adult</subject><subject>Aged</subject><subject>Biomarkers - blood</subject><subject>Blood Glucose - drug effects</subject><subject>Blood Glucose - metabolism</subject><subject>Chi-Square Distribution</subject><subject>Diabetes Mellitus - blood</subject><subject>Diabetes Mellitus - diagnosis</subject><subject>Diabetes Mellitus - drug therapy</subject><subject>Diabetes Mellitus - mortality</subject><subject>Female</subject><subject>Glucose Tolerance Test</subject><subject>Glycated Hemoglobin A - metabolism</subject><subject>Humans</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Kaplan-Meier Estimate</subject><subject>Lung Transplantation - adverse effects</subject><subject>Lung Transplantation - mortality</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Victoria</subject><issn>0041-1337</issn><issn>1534-6080</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kFFLwzAUhYMobk5_gSB59KXzZmma9lGmTmHg0In4VNL01kWzZibtZP_eylTEB-_L5cJ3zj0cQo4ZDBlk8mw-G8KvYUKIHdJngsdRAinskj5AzCLGueyRgxBeOkhwKfdJbyRllgqW9MnTzDlPJ3ajcWk0Hbu68c7Sm0DPQ3DaqAZL-miaBb1A7VGF7rxv_dqslaWmptO2fqZzr-qwsqpu6B1qszJYN-GQ7FXKBjz62gPycHU5H19H09vJzfh8GukYuIgKnSWgBGRpIRJRcawUQAEKZVJpEAWToFJVxGURM6hK_cnFZVYAV2VSVjEfkNOt78q7txZDky9N0Gi7OOjakLOUC4BRPIIO5VtUexeCxypfebNUfpMzyD87zeez_G-nnerk60FbLLH80XyX2AFyC7w726APr7Z9R58vUNlm8a_1B-XGgu8</recordid><startdate>201709</startdate><enddate>201709</enddate><creator>Hackman, Kathryn L</creator><creator>Snell, Gregory I</creator><creator>Bach, Leon A</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201709</creationdate><title>Poor Glycemic Control Is Associated With Decreased Survival in Lung Transplant Recipients</title><author>Hackman, Kathryn L ; Snell, Gregory I ; Bach, Leon A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4035-bc960a5098b565f3efa00b0ae76fc05b170a8ab4db410fdc98b54d9b03ad6df43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biomarkers - blood</topic><topic>Blood Glucose - drug effects</topic><topic>Blood Glucose - metabolism</topic><topic>Chi-Square Distribution</topic><topic>Diabetes Mellitus - blood</topic><topic>Diabetes Mellitus - diagnosis</topic><topic>Diabetes Mellitus - drug therapy</topic><topic>Diabetes Mellitus - mortality</topic><topic>Female</topic><topic>Glucose Tolerance Test</topic><topic>Glycated Hemoglobin A - metabolism</topic><topic>Humans</topic><topic>Hypoglycemic Agents - therapeutic use</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Kaplan-Meier Estimate</topic><topic>Lung Transplantation - adverse effects</topic><topic>Lung Transplantation - mortality</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Victoria</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hackman, Kathryn L</creatorcontrib><creatorcontrib>Snell, Gregory I</creatorcontrib><creatorcontrib>Bach, Leon A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hackman, Kathryn L</au><au>Snell, Gregory I</au><au>Bach, Leon A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Poor Glycemic Control Is Associated With Decreased Survival in Lung Transplant Recipients</atitle><jtitle>Transplantation</jtitle><addtitle>Transplantation</addtitle><date>2017-09</date><risdate>2017</risdate><volume>101</volume><issue>9</issue><spage>2200</spage><epage>2206</epage><pages>2200-2206</pages><issn>0041-1337</issn><eissn>1534-6080</eissn><abstract>BACKGROUNDDiabetes mellitus (DM) is associated with increased mortality after transplantation, but the effect of glycemic control on survival is unknown.We sought to determine the relationship between glycemic control (random blood glucose [RBG], fasting blood glucose [FBG], and glycated hemoglobin [HbA1c]) and survival in all lung transplant (LTx) recipients and those with either persistent or no DM.
METHODSAll 210 LTx recipients from August 1, 2010 to November 1, 2013, were included (median observation 3.0 years). All underwent oral glucose tolerance tests pre-LTx and serially post-LTx. All glucose and HbA1c results from LTx until study end were included, and hazard ratios were calculated.
RESULTSOf 210 patients, 90 had persistent DM, and 84 had no DM. Overall mortality/repeat LTx was 31%. In the whole cohort, each 1 mM (18 mg/dL) increase in mean FBG and RBG and each 1% increase in mean HbA1c were associated with mortality increases of 18% (95% confidence interval [CI], 5-32%, P = 0.006), 38% (95% CI, 15-65%; P < 0.001), and 46% (95% CI, 15-85%; P = 0.002), respectively. RBG correlated with mortality in the persistent DM and no DM groups, 37% (95% CI, 7-75%; P = 0.012) and 109% (95% CI, 3-323%; P = 0.041) increases/1 mM, respectively).
CONCLUSIONSGlycemic control strongly correlates with survival after LTx. RBG predicted mortality overall and in patients with and without DM. We propose hyperglycemia be managed promptly after LTx.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>27798516</pmid><doi>10.1097/TP.0000000000001555</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Aged Biomarkers - blood Blood Glucose - drug effects Blood Glucose - metabolism Chi-Square Distribution Diabetes Mellitus - blood Diabetes Mellitus - diagnosis Diabetes Mellitus - drug therapy Diabetes Mellitus - mortality Female Glucose Tolerance Test Glycated Hemoglobin A - metabolism Humans Hypoglycemic Agents - therapeutic use Immunosuppressive Agents - therapeutic use Kaplan-Meier Estimate Lung Transplantation - adverse effects Lung Transplantation - mortality Male Middle Aged Multivariate Analysis Odds Ratio Proportional Hazards Models Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome Victoria |
| title | Poor Glycemic Control Is Associated With Decreased Survival in Lung Transplant Recipients |
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