Hyperglycaemia and pulmonary infections in end-stage pre-transplant cystic fibrosis

Brenninkmeijer, V. (Veerle) (2015) Hyperglycaemia and pulmonary infections in end-stage pre-transplant cystic fibrosis. thesis, Medicine.

Text BrenninkmeijerV.pdf Restricted to Registered users only Download (1MB)

Abstract

1 Abstract in English Objective This study was conducted to determine whether CF- Related Diabetes (CFRD) is associated with higher pulmonary infection rates in CF patients with end-stage pretransplant lung disease. We also studied other factors (gender, age, pulmonary function, BMI, colonized organisms and diabetes characteristics) potentially associated with an increased risk of pulmonary infections. Methods A retrospective observational study of 90 CF patients who were accepted for the lung transplant waiting list between January 1998 and March 2015 was carried out. Data of pulmonary infections were collected for the period between the date of lung transplant waiting list acceptance and either (1) lung transplantation date; (2) date of death; or (3) March 1st 2015 (patients still on waiting list). Pulmonary infections were defined as severe pulmonary exacerbations requiring intravenous antibiotics. Pulmonary infections were analysed in three ways: the number of pulmonary exacerbations per year on the waiting list, the percentage of infection days during the study period and the mean number of IV treatment days. The contribution of confounding variables was examined using a stepwise multiple regression analysis with one of the pulmonary infection variables as the independent variable. Results Data from 90 CF patients (63 CFRD and 27 CF non-RD patients), mean age (SD), 30.0 (9.7) years were available. The three pulmonary infection parameters were comparable in the CFRD and CF non-RD group. Factors associated with a higher pulmonary exacerbation rate per year on the waiting list were: rate of change in FEV1 (Beta -0.1, P<0.003) and FEV1 at baseline (Beta -0.1, P<0.03). Factors associated with a higher percentage of infection days were: Burkholderia cepacia complex colonization (Beta 3.4, P<0.01) and last measured FEV1 (Beta -0.1, P<0.02). Factors associated with a higher mean number of IV treatment days were: last measured FEV1 (Beta-0.1, P<0.02) and Burkholderia cepacia complex colonization (Beta 1.6, P<0.05). A higher number of pulmonary exacerbations per year on the waiting list was the only significant risk factor for mortality on the waiting list (hazard ratio 1.4, P<0.004). Conclusion CFRD patients were not at increased risk of pulmonary infections in end-stage lung disease. Our study identified the following risk factors for pulmonary infections in end-stage CF: worse pulmonary function, colonization with Burkholderia cepacia complex and a younger age at lung transplant waiting list acceptance. CFRD characteristics that were associated with an increased risk of pulmonary infections were a younger age at CFRD diagnosis, a shorter duration of CFRD and hyperglycaemia. End-stage CF patients with high pulmonary exacerbation rates have an increased risk of death on the waiting list.

Item Type:	Thesis (Thesis)
Supervisor name:	Links, Prof. Dr. T.P. Internist – and Endocrinologist, University Medical Center and Groningen.
Supervisor name:	Valk, Dr. H.W. de Internist – Endocrinologist and University Medical Centre Utrecht.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:44
Last Modified:	25 Jun 2020 10:44
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/556

Actions (login required)

View Item