Trusted Resources: Evidence & Education
Scientific literature and patient education texts
Hospitalization for Acute Pain in Sickle Cell Disease: Changes in Clinical Parameters and Factors Predicting Hospital Discharge and Re-Admission
source: American Society of Hematology
year: 2016
authors: Mehdi Nouraie, Debra L Weiner, Mariana Hildesheim, Ward Hagar, Oswaldo L Castro, Sophie Lanzkron, Victor R. Gordeuk, James F. Casella, Mark T. Gladwin, Gregory J. Kato
summary/abstract:Introduction: Acute vaso-occlusive crisis (VOC) is the hallmark clinical complication of sickle cell disease (SCD). VOC involves several mechanisms, including rigid erythrocytes, adhesive blood cells, activated coagulation, activated and dysregulated endothelium, inflammation, and ischemia-reperfusion injury. Surprisingly few data document clinical and laboratory markers that change from steady state to VOC and during the hospital stay, and that predict subsequent rehospitalization. We characterized such markers in this study.
Methods: Data were collected as part of a clinical trial of nitric oxide as potential treatment for VOC (DeNOVO). Participants, age >= 10 years requiring hospitalization for VOC, were recruited from 11 academic medical centers at the time of VOC. Length of hospital stay (LOS), change in visual analogue scale (VAS) pain score, and hospital readmission within 30 days were study outcomes. Steady state laboratory values were available in a subgroup of patients for comparison. Differences between admission and steady state laboratory measures and changes in clinical and laboratory parameters from hospital admission to discharge were analyzed by Wilcoxon signed-rank test. Multivariate linear and logistic regression analyses were used to identify the independent predictors of LOS and 30-day readmission risk.
Results: 150 recruited patients had a median (interquartile range; IQR) age of 24 (17-33) years; 50% were female, and 91% had HbSS genotype. The median VAS score at time of admission was 7.7 cm which subsided to 3.3 cm at time of discharge (P <0.001). Serum lactate dehydrogenase concentrations (LDH) and neutrophils counts increased from steady state to the time of the VOC (P =< 0.001) and then decreased during the hospital stay (P =< 0.01) (Figure). The median (IQR) LOS was 3.5 (1.9-6.0) days. Longer LOS was predicted by higher admission VAS and serum alkaline phosphatase level, as well as higher increase in respiratory rate during hospital stay (P =< 0.006) (Table). The rate of 30-day hospital/ED readmission was 24%. Longer LOS was associated with lower risk of readmission (OR = 0.65, 95% CI: 0.50-0.86 per day). Other risk factors for readmission were higher serum creatinine at discharge (OR = 5.54, 95% CI: 1.12-27.51 per mg/dL), greater increase in serum alanine aminotransferase (OR = 1.03, 95%CI: 1.01-1.06 per unit increase) and greater cumulative opioid doses (OR = 1.25, 95%CI: 1.11-1.49 per 100 mg) during the index hospitalization.
Conclusion: VOC is associated with neutrophilia and increased LDH, consistent with inflammation and hemolysis and/or tissue injury, although of insufficient magnitude to be used as diagnostic criteria. The magnitude of pain and marker of apparent bone involvement predict longer LOS. SCD patients with VOC carry a high burden of readmission risk, which is characterized by higher opioid utilization and earlier discharge from the index hospitalization. These concepts can shape models, especially to reduce readmission rate, to be evaluated in prospective clinical trials.
organization: University of Pittsburgh; Boston Children’s Hospital, Harvard Medical School, Boston; Children's Hospital & Research Center Oakland; Howard University, Washington, DC; The Johns Hopkins University School of Medicine, Baltimore; University of Illinois at Chicagoread more
Related Content
-
The Cellie Coping Kit helps sick kids manage the stress of treatmentDesigned by Marsac during her fellowship...
-
Susan Claster, MDDr. Claster graduated from the Universit...
-
Sickle Cell Disease: Splenic SequestrationSplenic sequestration is a problem with ...
-
Isaac Odame, MB ChB, MRCP, FRCPath, FRCPCH, FRCPCDr. Isaac Odame is a staff physician and...
-
Living With Unpredictable Pain: A Sickle Cell Disease StoryGrowing up, Vismel Marquez wanted to joi...
-
Small chips, big impact: MSU researcher studies cardiovascular, sickle cell diseaseA Mississippi State University researche...
-
Red blood cell transfusion to treat or prevent complications in sickle cell disease: An overview of Cochrane reviewsBackground: Globally, sickle cell disea...
To improve your experience on this site, we use cookies. This includes cookies essential for the basic functioning of our website, cookies for analytics purposes, and cookies enabling us to personalize site content. By clicking on 'Accept' or any content on this site, you agree that cookies can be placed. You may adjust your browser's cookie settings to suit your preferences. More Information
The cookie settings on this website are set to "allow cookies" to give you the best browsing experience possible. If you continue to use this website without changing your cookie settings or you click "Accept" below then you are consenting to this.