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Ajibawo T, Okunowo O. Chronic kidney disease and outcomes in hospitalized sickle cell disease patients: A National Inpatient Sample analysis. Eur J Haematol 2024. [PMID: 38511273 DOI: 10.1111/ejh.14201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES To examine the association between chronic kidney disease (CKD) and outcomes in sickle cell disease (SCD) patients. METHODS Patients ≥18 years with SCD in the National Inpatient Sample database between 2016 and 2018 were identified using ICD-10-CM diagnosis codes. A 1:1 propensity-score matched analysis was performed to compare in-hospital outcomes of patients with and without CKD. RESULTS Of the 366 240 SCD admissions, 19 365 (5.3%) had CKD. The CKD group had higher odds of in-hospital mortality (odds ratio [OR] 2.59, 95% confidence interval [CI]: 1.63-4.12, p = <.01), blood transfusion (OR 1.67, 95% CI: 1.47-1.90, p < .01), mechanical ventilation (OR 2.20, 95% CI: 1.56-3.12, p = <.01), sepsis (OR 1.75, 95% CI: 1.46-2.10, p < .01), incurred higher costs ($53 255 vs. $47 294, p < .001), but had lower odds of acute chest syndrome (OR 0.71, 95% CI: 0.54-0.95, p = 0.02) and pulmonary embolism (OR 0.45, 95% CI: 0.31-0.67, p < .01). CONCLUSIONS CKD was associated with higher mortality, higher costs, blood transfusion, sepsis, and mechanical ventilation in SCD patients. Further studies are needed to explore the reasons for the reduced odds of pulmonary embolism and acute chest syndrome.
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Affiliation(s)
| | - Oluwatimilehin Okunowo
- Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute of City of Hope, Duarte, California, USA
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Chamberlin JH, Ogbonna A, Abrol S, Maisuria D, Miller E, McGuire A, Knight H, O'Doherty J, Baruah D, Schoepf UJ, Munden RF, Kabakus IM. Enhancing diagnostic precision for acute chest syndrome in sickle cell disease: insights from dual-energy CT lung perfusion mapping. Emerg Radiol 2024; 31:73-82. [PMID: 38224366 DOI: 10.1007/s10140-024-02200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE Acute chest syndrome (ACS) is secondary to occlusion of the pulmonary vasculature and a potentially life-threatening complication of sickle cell disease (SCD). Dual-energy CT (DECT) iodine perfusion map reconstructions can provide a method to visualize and quantify the extent of pulmonary microthrombi. METHODS A total of 102 patients with sickle cell disease who underwent DECT CTPA with perfusion were retrospectively identified. The presence or absence of airspace opacities, segmental perfusion defects, and acute or chronic pulmonary emboli was noted. The number of segmental perfusion defects between patients with and without acute chest syndrome was compared. Sub-analyses were performed to investigate robustness. RESULTS Of the 102 patients, 68 were clinically determined to not have ACS and 34 were determined to have ACS by clinical criteria. Of the patients with ACS, 82.4% were found to have perfusion defects with a median of 2 perfusion defects per patient. The presence of any or new perfusion defects was significantly associated with the diagnosis of ACS (P = 0.005 and < 0.001, respectively). Excluding patients with pulmonary embolism, 79% of patients with ACS had old or new perfusion defects, and the specificity for new perfusion defects was 87%, higher than consolidation/ground glass opacities (80%). CONCLUSION DECT iodine map has the capability to depict microthrombi as perfusion defects. The presence of segmental perfusion defects on dual-energy CT maps was found to be associated with ACS with potential for improved specificity and reclassification.
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Affiliation(s)
- Jordan H Chamberlin
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Alexis Ogbonna
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Sameer Abrol
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Dhruw Maisuria
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Emily Miller
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Aaron McGuire
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Heather Knight
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Jim O'Doherty
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
- Siemens Medical Solutions, Malvern, PA, USA
| | - Dhiraj Baruah
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - U Joseph Schoepf
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Reginald F Munden
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Ismail M Kabakus
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA.
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Baldwin MK, Bannow BS, Rosovsky RP, Sokkary N, Srivaths LV. Individualized risk assessment for use of hormone therapy in people with sickle cell disease. Res Pract Thromb Haemost 2024; 8:102297. [PMID: 38249437 PMCID: PMC10797204 DOI: 10.1016/j.rpth.2023.102297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/20/2023] [Indexed: 01/23/2024] Open
Affiliation(s)
- Maureen K. Baldwin
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Oregon Health & Science University, Portland, Oregon, USA
| | - Bethany Samuelson Bannow
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Oregon Health & Science University, Portland, Oregon, USA
| | - Rachel P. Rosovsky
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Division of Hematology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Sokkary
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Department of Obstetrics and Gynecology, Children’s Healthcare of Atlanta/Emory School of Medicine, Atlanta, Georgia, USA
| | - Lakshmi V. Srivaths
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Department of Pediatrics, Gulf States Hemophilia and Thrombophilia Center, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
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