The effect of the presence of concomitant diabetes mellitus or steroid-induced diabetes mellitus in immune hematological diseases on some inflammatory markers and prognosis

Introduction and Objective: Steroids are the first choice for the treatment of life-threatening immunological hematological diseases such as immune thrombocytopenic purpura (ITP), immune thrombotic thrombocytopenic purpura (iTTP) and autoimmune hemolytic anemia (AIHA). Steroids are powerful anti-inflammatory and immunosuppressive drugs, they are widely used in the treatment of many diseases. Despite their therapeutic efficacy, steroids have many side effects, one of the most well-known of which is hyperglycemia and the development of diabetes mellitus. Steroid-induced diabetes is a common medical problem that can lead to hospitalization and prolonged hospital stay. In this study, we aimed to investigate the effects of diabetes mellitus (DM), steroid-induced diabetes mellitus (Si-DM) and glucose metabolism disorders on inflammatory parameters and prognosis in immune hematological diseases. Materials and Methods: Patients who were evaluated with the diagnosis of ITP, iTTP and AIHA in the Celal Bayar University (CBU) Hafsa Sultan Hospital Hematology service and outpatient clinic between January 2021 and January 2024 were retrospectively examined; demographic data of these patients (age, gender, weight, height, BMI), history, laboratory, information on imaging results (abdominal ultrasonography), comorbidities before and at the time of diagnosis, medications used, treatments received and overall survival were recorded retrospectively by scanning the hospital information management system. Results: The study included 112 patients, 66 (58.9%) with ITP, 18 (16.0%) with iTTP, and 28 (25.1%) with AIHA. Of the patients included in the study, 22 (19.6%) had prediabetes, 20 (17.9%) had previous DM (pDM), and 58 (63.0%) had steroid-induced DM (Si-DM). Of the 66 ITP patients, 11 (16.7%) had pDM and 35 (53.0%) had Si-DM. Of those with iTTP, 1 (5.6%) had pDM and 10 (55.5%) had Si-DM. Among the patients diagnosed with AIHA, 8 (28.5%) were diagnosed with pDM and 13 (46.4%) with Si-DM, and no statistically significant relationship was found between the disease diagnosis groups and pDM or Si-DM (p=0.088). A significant relationship was found between the age, BMI and weight of the patients and whether they had pDM or Si-DM. Among the laboratory values of patients previously diagnosed with DM, increased urea (p=0.009), glucose (p<0.001), triglyceride (p=0.048) and HbA1C (p=0.002) and decreased GFR (p=0.002) were found to be statistically significant. Among the inflammatory parameters, NLR was higher in patients with Si-DM; PLR, MLR, MPV, RDW and PNI were higher in patients without DM, but the difference was not found to be statistically significant. In patients with ITP, MPV was significantly higher and PLR was lower than in iTTP. NLR levels were higher in iTTP and AIHA patients than in ITP patients, but no statistically significant difference was found between the diagnoses and NLR and PLR. According to the diagnosis groups, the highest PNI was found in ITP patients with a median of 52.8 (32.3-81) and the lowest PNI was found in those with AIHA with a median of 47.15 (25-65.7), and a statistically significant relationship was found between PNI and disease diagnoses (p=0.004). Although PNI was highest in patients without DM (50.58±8.12) and lowest in those with previous DM (47.73±6.01), no statistical significance was found between PNI and DM status (p=0.485). When the patients were examined in terms of whether they were admitted to the ward for treatment, it was seen that 74.1% of the patients were admitted. Since the initial treatments of the 18 iTTP patients in the study required admission, it was determined that all patients were admitted. It was seen that 74.2% of those diagnosed with ITP and 57.1% of those diagnosed with AIHA were admitted. A significant relationship was found between disease diagnosis groups and hospitalization. It was seen that the patients who were admitted were mostly those diagnosed with DM (80%). No statistical significance was found between having pDM or Si-DM and hospitalization. The number of hospitalizations was found to be higher in patients with DM and steroid-dependent DM. A statistically significant relationship was found between the number of hospitalizations and diagnoses (p=0.005). No significance was found according to previous DM or Si-DM (p=0.467). When the average hospitalization period was examined, it was found that the longest hospitalization period was in those with Si-DM with 14.97±12.32 days. According to the disease diagnosis groups, the longest hospitalization was found in ITP patients. A statistically significant relationship was found between the hospitalization period and disease diagnosis groups; however, no significance was found with the presence of pDM or Si-DM. According to the follow-up periods, the longest follow-up was found in those diagnosed with pDM, and the shortest follow-up was found in those without DM. According to the disease diagnosis groups, the longest follow-up was found in those diagnosed with ITP, and the shortest follow-up was found in those diagnosed with pDM. Statistically, a significant difference was found between the follow-up period and disease diagnosis groups, but no significant difference was found according to whether pDM or Si-DM. In patients diagnosed with ITP, iTTP and AIHA, no statistically significant relationship was found between treatment response and whether they had pDM or Si-DM. When survival rates were examined, although the mortality rate was higher in those diagnosed with DM, no statistically significant difference was found between survival and having pDM or Si-DM. When examined according to diagnosis, the lowest mortality rate was found in ITP patients and the highest mortality rate was found in AIHA patients, and statistical significance was found between survival and disease diagnosis groups. Conclusion: It is observed that the frequency of DM and prediabetes is higher in patients with immune hematological diseases than in the general population. In studies conducted, the frequency of Si-DM is also quite high in immune hematological diseases compared to other diseases. This situation requires significant treatment changes and hospitalization in patients. It is important to identify patients with a possibility of developing steroid-induced DM in advance, make dietary and other treatment arrangements, follow up the patients closely and inform the patient about Si-DM. Investigating the effects of diabetes and prognostic markers on the prognosis of immune hematological diseases with studies that follow more patients for longer periods will yield better results. Key words: Diabetes mellitus, immune thrombocytopenic purpura, immune thrombotic thrombocytopenic purpura, autoimmune hemolytic anemia, prognostic nutritional index, steroid-induced diabetes, inflammatory markers