Hyperglycemia increases the complicated infection and mortality rates during induction therapy in adult acute leukemia patients

OBJECTIVE: To determine the prevalence of hyperglycemia during induction therapy in adult patients with acute leukemia and its effect on complicated infections and mortality during the first 30 days of treatment. METHODS: An analysis was performed in a retrospective cohort of 280 adult patients aged 18 to 60 years with previously untreated acute leukemia who received induction chemotherapy from January 2000 to December 2009 at the Hemocentro de Pernambuco (HEMOPE), Brazil. Hyperglycemia was defined as the finding of at least one fasting glucose measurement > 100 mg/dL observed one week prior to induction therapy until 30 days after. The association between hyperglycemia and complicated infections, mortality and complete remission was evaluated using the Chi-square or Fisher's exact tests by the Statistical Package for Social Sciences (SPSS) in the R software package version 2.9.0. RESULTS: One hundred and eighty-eight patients (67.1%) presented hyperglycemia at some moment during induction therapy. Eighty-two patients (29.3%) developed complicated infections. Infection-related mortality during the neutropenia period was 20.7% (58 patients). Mortality from other causes during the first 30 days after induction was 2.8%. Hyperglycemia increased the risk of complicated infections (OR 3.97; 95% confidence interval: 2.08 - 7.57; p-value < 0.001) and death (OR 3.55; 95% confidence interval: 1.77-7.12; p-value < 0.001) but did not increase the risk of fungal infections or decrease the probability of achieving complete remission. CONCLUSION: This study demonstrates an association between the presence of hyperglycemia and the development of complicated infections and death in adult patients during induction therapy for acute leukemia

Clinical and laboratory characteristics, staging, and outcomes of individuals with AIDS-associated Kaposi's sarcoma at an university hospital

Submitted by Adagilson Silva ([email protected]) on 2017-06-19T19:20:13Z No. of bitstreams: 1 28538874 2017 lim-clin.oa.pdf: 287529 bytes, checksum: c9afa11ebf83a86fc4e42c532ae83f6d (MD5)Approved for entry into archive by Adagilson Silva ([email protected]) on 2017-06-19T19:21:51Z (GMT) No. of bitstreams: 1 28538874 2017 lim-clin.oa.pdf: 287529 bytes, checksum: c9afa11ebf83a86fc4e42c532ae83f6d (MD5)Made available in DSpace on 2017-06-19T19:21:51Z (GMT). No. of bitstreams: 1 28538874 2017 lim-clin.oa.pdf: 287529 bytes, checksum: c9afa11ebf83a86fc4e42c532ae83f6d (MD5) Previous issue date: 2017Commission and Hospital Infection Control Service of the Hospital Barão de Lucena. Recife, PE, Brazil.Universidade Federal de Pernambuco. Department of Tropical Medicine. Recife, PE, Brazil / Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Recife, PE, Brasil.Real Hospital Português de Beneficência de Pernambuco. Department of Clinical Oncology. Recife, PE, Brazil / Hospital Barão de Lucena. Department of Clinical Oncology. Recife, PE, Brazil.Universidade Federal de Pernambuco. Department of Tropical Medicine. Recife, PE, Brazil / Dermatology Service of the Hospital das Clínicas of the Universidade Federal de Pernambuco (HC-UFPE). Recife, PE, Brazil.Universidade Federal de Pernambuco. Department of Tropical Medicine. Recife, PE, Brazil.Background: Kaposi's sarcoma continues to be the most common human immunodeficiency virus - associated neoplasm with considerable morbidity and mortality. Objective: To describe the clinical and laboratory characteristics, initial staging, and outcomes of aids patients with Kaposi's sarcoma at an university hospital of Recife, Pernambuco. Methods: This is a descriptive study with analytic character, retrospective, of a case series between 2004 and 2014. Results: Of the 22 patients included in the study, 20 were aged <40 years (72.7%). The majority had CD4+ T lymphocyte counts of <200 cells/mm3 (77.3%) and human immunodeficiency virus loads of <100,000 copies/mL (78.9%). Lesions were most commonly observed on the skin (90%), and internal organs were affected in 11 of the 22 patients. Only 7 (31.8%) of the 22 patients were undergoing antiretroviral therapy (ART) at the time of Kaposis sarcoma diagnosis, and the initial disease staging classification was high risk (Aids Clinical Trials Group Oncology Committee) in 19 of the 22 patients (86.4%). Regarding Kaposi's sarcoma treatment, 17 of 22 patients (77.3%) underwent systemic chemotherapy + ART and 5 were treated exclusively with ART. Eight of the 22 patients died (36.5%); of these, 87.5% had died within one year of Kaposi's sarcoma diagnosis. Limitation of the study: Without a control group, this study cannot be used to generate hypotheses. Conclusions: Despite the association between aids and late Kaposi's sarcoma diagnosis in the study population, including an unfavorable risk at the time of staging, a lower mortality rate was observed relative to other studies; this might be related to access to a specialized health service