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Outcomes of Adult Patients With Sickle-Cell Disease Admitted to the ICU: A Case Series.
Crit Care Med. 2014 Mar 26;
Authors: Cecchini J, Lionnet F, Djibré M, Parrot A, Stojanovic KS, Girot R, Fartoukh M
Abstract
OBJECTIVE:: Sickle-cell disease is associated with a decreased life expectancy, half of the deaths occurring in the ICU. We aimed to describe the characteristics of sickle-cell disease patients admitted to ICU and to identify early predictors of a complicated outcome, defined as the need for vital support or death.
DESIGN:: Retrospective observational cohort study of sickle-cell disease patients over a 6-year period.
SETTING:: ICU of a French teaching hospital and sickle-cell disease referral center.
PATIENTS:: Hundred thirty-eight ICU admissions in 119 sickle-cell disease patients.
INTERVENTIONS:: None.
MEASUREMENTS AND MAIN RESULTS:: ICU admission was mainly indicated for sickle-cell disease-related events, especially acute chest syndrome. Mechanical ventilation, vasoactive drugs, and renal replacement therapy were administered to 25 (18%), 10 (7%), and 10 (7%) episodes, respectively. The complicated outcome group (n = 28; 20%) was characterized by a more aggressive acute disease within the 48 hours preceding ICU admission, with a higher respiratory rate, a more frequent acute kidney injury, and a more sustained drop of hemoglobin (all p < 0.01). All nine deaths (7%) were sickle-cell disease related. None of the sickle-cell disease baseline characteristics predicted accurately a complicated outcome. In multivariate analysis, hemoglobin less than or equal to 7.8 g/dL (odds ratio, 3.6; 95% CI, 1.1-11.9), respiratory rate more than or equal to 32 cycles/min (odds ratio, 5.6; 95% CI, 1.8-17.2), and acute kidney injury on ICU admission (odds ratio, 11.5; 95% CI, 2.5-52.6) were independently associated with a complicated outcome.
CONCLUSIONS:: Sickle-cell disease patients are at high risk of complications when admitted to the ICU. A sustained drop of hemoglobin, acute respiratory distress, and kidney injury at admission are strong predictors of a complicated outcome.
PMID: 24674925 [PubMed - as supplied by publisher]