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Michelon I, Vilbert M, Pinheiro IS, Costa IL, Lorea CF, Castonguay M, Tran TH, Forté S. COVID-19 outcomes in patients with sickle cell disease and sickle cell trait compared with individuals without sickle cell disease or trait: a systematic review and meta-analysis. EClinicalMedicine 2023; 66:102330. [PMID: 38162948 PMCID: PMC10755716 DOI: 10.1016/j.eclinm.2023.102330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024] Open
Abstract
Background Clinical manifestations and severity of SARS-CoV-2 infection in individuals with sickle cell disease (SCD) and sickle cell trait (SCT) are not well understood yet. Methods We performed a systematic review and meta-analysis to assess COVID-19 outcomes in individuals with SCD or SCT compared to individuals without sickle cell disease or trait. An electronic search on PubMed, Embase, and Cochrane Library was performed on August 3, 2023. Two authors (IFM and ISP) independently screened (IFM and ISP) and extracted data (IFM and ILC) from included studies. Main exclusion criterion was the absence of the non-SCD/SCT group. Exposure effects for binary endpoints were compared using pooled odds ratio (OR) with 95% confidence intervals (CI). I2 statistics was used to assess the heterogeneity and DerSimonian and Laird random-effects models were applied for all analyses to minimize the impact of differences in methods and outcomes definitions between studies. The overall quality of evidence was assessed using the GRADE system. Review Manager 5.4 and R software (v4.2.2) were used for statistical analyses. Registered with PROSPERO, CRD42022366015. Findings Overall, 22 studies were included, with a total of 1892 individuals with SCD, 8677 individuals with SCT, and 1,653,369 individuals without SCD/SCT. No difference in all-cause mortality was seen between SCD/SCT and non-SCD/SCT (OR 1.18; 95% CI 0.78-1.77; p = 0.429; I2 = 82%). When considering only studies adjusted for confounders (8 studies), patients with SCD/SCT were shown to be at increased risk of death (OR 1.86; 95% CI 1.30-2.66; p = 0.0007; I2 = 34%). No significant difference was seen between individuals with SCD and SCT (p = 0.863). The adjusted for confounders analysis for hospitalisation revealed higher rates for the SCD (OR 5.44; 95% CI 1.55-19.13; p = 0.008; I2 = 97%) and the SCT groups (OR 1.31; 95% CI 1.10-1.55; p = 0.002; I2 = 0) compared to the non-SCD/SCT population. Moreover, it was significantly higher for the SCD group (test for subgroup difference; p = 0.028). Interpretation Our findings suggest that patients with SCD or SCT may present with a higher mortality and hospitalisation rates due to COVID-19 infection. Funding None.
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Affiliation(s)
- Isabella Michelon
- Department of Medicine, School of Medicine, Catholic University of Pelotas, Pelotas, Brazil
| | - Maysa Vilbert
- Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Isabela Lino Costa
- Department of Medicine, School of Medicine, Federal University of Mineiro Triangle, Uberaba, Brazil
| | | | - Mathias Castonguay
- Department of Medicine, Centre Hospitalier de l’Université de Montréal, Quebec, Canada
| | - Thai Hoa Tran
- Division of Paediatric Hematology and Oncology, Department of Pediatrics, Centre Hospitalier Universitaire de Sainte-Justine, Montréal, Quebec, Canada
| | - Stéphanie Forté
- Division of Hematology and Medical Oncology, Departement of Medicine, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Carrefour de l'Innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, Canada
- Division of Hematology and Medical Oncology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
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Dubois G, Virot E, Marie M, Poutrel S, Cannas G, Hot A. Impact of COVID-19 on incidence, clinical presentation, and prognosis of acute chest syndrome in patients with sickle cell disease. EJHAEM 2023; 4:970-976. [PMID: 38024591 PMCID: PMC10660110 DOI: 10.1002/jha2.768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/01/2023] [Accepted: 08/02/2023] [Indexed: 12/01/2023]
Abstract
Acute chest syndrome (ACS) is a frequent complication of sickle cell disease (SCD). Because coronavirus disease 2019 (COVID-19) increases mortality and morbidity in many diseases, we retrospectively analyzed the impact of SARS-CoV-2 infection on the incidence, the clinical presentation, and the prognosis of ACS in patients with SCD by comparing ACS episode before and during COVID-19 pandemic. Ninety-nine episodes of ACS were registered over 24 months before pandemic versus 81 episodes over 24 months during the pandemic period. The number of ACS episodes varies among children regarding the two period of time: 26 episodes (26%) for the pre-pandemic period versus 11 episodes (13%) for the pandemic period (p = 0.03). Comparisons between adults and children showed a higher incidence of initial VOC (45% vs. 24%; p = 0.04) in adults, and a higher incidence of initial pneumonia (35% vs. 15%; p = 0.01) and documented infection (35% vs. 7%; p < 0.001) in children. One patient died during the pandemic period but without any relationship with ACS or COVID-19. During this pandemic period, 13 episodes of ACS (16%) were found related to coronavirus infection. These ACS episodes did not show any significant differences in terms of outcome when compared to the other ACS episodes observed during this period. Overall, coronavirus infection did not demonstrate a negative impact on incidence, clinical presentation, and outcome of ACS in patients with SCD. Early management, chronic treatment with HU, and exchange transfusions could likely explain the low morbidity and mortality rates.
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Affiliation(s)
- Gabin Dubois
- Emergency Department, Hospices Civils de LyonEdouard Herriot HospitalLyonFrance
| | - Emilie Virot
- Internal Medicine, Hospices Civils de LyonEdouard Herriot HospitalLyonFrance
- Constitutive Reference Center: Major Sickle Cell Syndromes, Thalassemias and Other Rare Pathologies of Red Blood Cell and ErythropoiesisEdouard Herriot HospitalLyonFrance
| | - Manon Marie
- Internal Medicine, Hospices Civils de LyonEdouard Herriot HospitalLyonFrance
- Constitutive Reference Center: Major Sickle Cell Syndromes, Thalassemias and Other Rare Pathologies of Red Blood Cell and ErythropoiesisEdouard Herriot HospitalLyonFrance
| | - Solène Poutrel
- Internal Medicine, Hospices Civils de LyonEdouard Herriot HospitalLyonFrance
- Constitutive Reference Center: Major Sickle Cell Syndromes, Thalassemias and Other Rare Pathologies of Red Blood Cell and ErythropoiesisEdouard Herriot HospitalLyonFrance
| | - Giovanna Cannas
- Internal Medicine, Hospices Civils de LyonEdouard Herriot HospitalLyonFrance
- Constitutive Reference Center: Major Sickle Cell Syndromes, Thalassemias and Other Rare Pathologies of Red Blood Cell and ErythropoiesisEdouard Herriot HospitalLyonFrance
| | - Arnaud Hot
- Internal Medicine, Hospices Civils de LyonEdouard Herriot HospitalLyonFrance
- Constitutive Reference Center: Major Sickle Cell Syndromes, Thalassemias and Other Rare Pathologies of Red Blood Cell and ErythropoiesisEdouard Herriot HospitalLyonFrance
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Liang T, Guo K, Ni P, Duan G, Zhang R. The association of sickle cell disorder with adverse outcomes in COVID-19 patients: A meta-analysis. J Med Virol 2023; 95:e29120. [PMID: 37772453 DOI: 10.1002/jmv.29120] [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: 03/06/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023]
Abstract
The aim is to elucidate the relationship between sickle cell disorder and severe COVID-19. We systematically searched the required articles in three electronic databases, extracting and pooling effect sizes (ES) and 95% confidence interval (CI) from each eligible study to evaluate the effect of combined sickle cell disorder on adverse consequences in patients with COVID-19. This meta-analysis included 21 studies. Sickle cell disease (SCD) was a risk factor for mortality (pooled ES = 1.70, 95% CI: 1.00-2.92, p = 0.001), hospitalization (pooled ES = 6.21, 95% CI: 3.60-10.70, p = 0.000) and intensive care unit (ICU) admission (pooled ES = 2.29, 95% CI: 1.61-3.24, p = 0.099) in COVID-19 patients. Patients with SCD had an increased risk of respiratory failure/mechanical ventilation, but a statistical association was not found (pooled ES = 1.21, 95%CI: 0.74-1.98, p = 0.036). There was significant heterogeneity between SCD and death, hospitalization, and respiratory failure/mechanical ventilation. The results of meta-regression of SCD and hospitalization suggested that the tested variables including Area (p = 0.642), study design (p = 0.739), sample size (p = 0.397), proportion of males (p = 0.708), effect type (p = 0.723), whether confounding factors are adjusted (p = 0.606) might not be the source of heterogeneity. In addition, sickle cell trait (SCT) was significantly associated with the mortality (pooled ES = 1.54, 95% CI: 1.28-1.85, p = 0.771) and hospitalization (pooled ES = 1.20, 95% CI: 1.07-1.35,p = 0.519) in patients with COVID-19. But any increased risk of ICU admission/severe (pooled ES = 1.24, 95% CI: 0.95-1.62, p = 0.520) and mechanical ventilation (OR = 1.00, 95%CI:0.59-1.69) in COVID-19 patients with SCT was not observed. Sensitivity analysis demonstrated that the results were robust. The results of the funnel plot and Egger's test did not support the existence of publication bias. Current meta-analysis indicated that sickle cell disorder has a meaningful impact on COVID-19 progression to severe cases and associated deaths. However, further investigations and research to validate the current findings is indispensable.
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Affiliation(s)
- Tianyi Liang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Kaixin Guo
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Peng Ni
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Rongguang Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
- International School of Public Health and One Health and The First Affiliated Hospital, Hainan Medical University, Haikou, China
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Varelas C, Gavriilaki E. Sickle Cell Disease: Current Understanding and Future Options. J Clin Med 2023; 12:5943. [PMID: 37762884 PMCID: PMC10532277 DOI: 10.3390/jcm12185943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
Sickle cell disease (SCD) is a prevalent inherited hemoglobin disorder encompassing a cluster of congenital hemolytic anemias, each distinguished by the prevalence of sickle hemoglobin (HbS) [...].
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Affiliation(s)
- Christos Varelas
- Hematology Department—BMT Unit, G .Papanicolaou Hospital, 57010 Thessaloniki, Greece
| | - Eleni Gavriilaki
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, 54644 Thessaloniki, Greece
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Aldali JA, Alotaibi BA, Aldali HJ, Alasiri GA, Alaseem A, Almuqrin AM, Alshalani A, Alotaibi FT. Assessing the Impact of COVID-19 Vaccines on Sickle Cell Anaemia Patients: A Comparative Analysis of Biochemical and Haematological Parameters. Biomedicines 2023; 11:2203. [PMID: 37626700 PMCID: PMC10452730 DOI: 10.3390/biomedicines11082203] [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: 06/30/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) vaccines have been developed to help prevent the spread of the virus infections. The COVID-19 vaccines, including Pfizer, Moderna, and AstraZeneca, have undergone rigorous testing and have demonstrated both safety and effectiveness. Extensive evidence supports their effectiveness in preventing severe illness, hospitalization, and mortality associated with COVID-19 infection. The administration of COVID-19 vaccines can directly affect hematological and biochemical parameters, with reported cases showing an association with thrombosis and thrombocytopenia. Therefore, it was hypothesized that COVID-19 vaccines may also influence hematological and biochemical markers in sickle cell patients. This study aimed to investigate the side effects of COVID-19 vaccines on sickle cell patients, providing a comprehensive evaluation of hematological and biochemical parameters. To our knowledge, this is the first study of its kind conducted in Saudi Arabia. The study included the evaluation of Pfizer and Oxford-AstraZeneca vaccines in sickle cell patients, measuring key parameters. Our findings revealed varying impacts of both vaccines on the ALT, AST, and CRP levels. Notably, CRP and ALT exhibited potential as indicators for renal disease, diabetes, and arthritis. However, further investigations are necessary to uncover the underlying mechanisms that drive these observed differences and comprehend their clinical implications for this vulnerable patient population. The unique nature of our study fills a crucial research gap and underscores the need for additional research in this area.
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Affiliation(s)
- Jehad A. Aldali
- Department of Pathology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia
| | - Badi A. Alotaibi
- Department of Clinical Laboratory Sciences, Collage of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
| | - Hamzah J. Aldali
- Cellular and Molecular Medicine, College of Biomedical Science, University of Bristol, Bristol BS8 1QU, UK
| | - Glowi A. Alasiri
- Department of Biochemistry, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia
| | - Ali Alaseem
- Department of Pharmacology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia
| | - Abdulaziz M. Almuqrin
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Abdulrahman Alshalani
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Fahad T. Alotaibi
- Department of Physiology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 5701, Saudi Arabia
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Martin OY, Darbari DS, Margulies S, Nickel RS, Leonard A, Speller-Brown B, Martin B, Barber JR, Webb J, Majumdar S, Sharron MP, Campbell AD. Clinical outcomes of children and adolescents with sickle cell disease and COVID-19 infection: A year in review at a metropolitan tertiary pediatric hospital. Front Med (Lausanne) 2023; 10:987194. [PMID: 36873869 PMCID: PMC9982154 DOI: 10.3389/fmed.2023.987194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/30/2023] [Indexed: 02/19/2023] Open
Abstract
Background COVID-19 was declared a global pandemic in March 2020. Early reports were primarily in adults, and sickle cell disease (SCD) was classified as a risk factor for severe COVID-19 disease. However, there are a limited number of primarily multi-center studies reporting on the clinical course of pediatric patients with SCD and COVID-19. Methods We conducted an observational study of all patients with SCD diagnosed with COVID-19 at our institution between March 31, 2020, and February 12, 2021. Demographic and clinical characteristics of this group were collected by retrospective chart review. Results A total of 55 patients were studied, including 38 children and 17 adolescents. Demographics, acute COVID-19 clinical presentation, respiratory support, laboratory findings, healthcare utilization, and SCD modifying therapies were comparable between the children and adolescents. Seventy-three percent (N = 40) of all patients required emergency department care or hospitalization. While 47% (N = 26) were hospitalized, only 5% (N = 3) of all patients required intensive care unit admission. Patients frequently had concurrent vaso-occlusive pain crisis (VOC) (N = 17, 43%) and acute chest syndrome (ACS) (N = 14, 35%). Those with ACS or an oxygen requirement had significantly higher white blood cell count, lower nadir hemoglobin, and higher D-dimers, supporting a pro-inflammatory and coagulopathic picture. Non-hospitalized patients were more likely to be on hydroxyurea than hospitalized patients (79 vs. 50%, p = 0.023). Conclusion Children and adolescent patients with SCD and acute COVID-19 often present with ACS and VOC pain requiring hospital-level care. Hydroxyurea treatment appears to be protective. We observed no mortality despite variable morbidity.
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Affiliation(s)
- Olufunke Y Martin
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, DC, United States
| | - Deepika S Darbari
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, DC, United States.,George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, DC, United States
| | - Stefanie Margulies
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, DC, United States
| | - Robert S Nickel
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, DC, United States.,George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, DC, United States
| | - Alexis Leonard
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, DC, United States.,George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, DC, United States
| | - Barbara Speller-Brown
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, DC, United States.,George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, DC, United States
| | - Brenda Martin
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, DC, United States
| | - John R Barber
- Department of Biostatistics and Study Methodology, Children's National Hospital, Washington, DC, United States
| | - Jennifer Webb
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, DC, United States.,George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, DC, United States
| | - Suvankar Majumdar
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, DC, United States.,George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, DC, United States
| | - Matthew P Sharron
- George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, DC, United States.,Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, United States
| | - Andrew D Campbell
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, DC, United States.,George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, DC, United States
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