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Soulié A, Kamdem A, Neumann F, Hau I, Madhi F, Delestrain C, Shum M, Carlier-Gonod A, Malterre A, Lezeau H, Khazem B, Belozertseva E, Guémas E, Epaud R, Pissard S, Arnaud C, Pondarré C. Clinical events in a long-term prospective neonatal cohort of children with sickle cell disease: Evidence for a high disease burden without systematic preventive intensification with hydroxyurea. Am J Hematol 2023; 98:E395-E398. [PMID: 37883505 DOI: 10.1002/ajh.27142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Alizée Soulié
- Pediatric Department, Sickle Cell Disease Referral Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Annie Kamdem
- Pediatric Department, Sickle Cell Disease Referral Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Florent Neumann
- Pediatric Department, Dijon University Hospital, Dijon, France
| | - Isabelle Hau
- Pediatric Department, Sickle Cell Disease Referral Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Paris XII University, IMRB-GRC GEMINI, Créteil, France
| | - Fouad Madhi
- Pediatric Department, Sickle Cell Disease Referral Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Paris XII University, IMRB-GRC GEMINI, Créteil, France
| | - Céline Delestrain
- Pediatric Department, Sickle Cell Disease Referral Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Paris XII University, INSERM, IMRB, Créteil, France
| | - Mickaël Shum
- Pediatric Department, Sickle Cell Disease Referral Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Paris XII University, INSERM, IMRB, Créteil, France
| | - Adèle Carlier-Gonod
- Pediatric Department, Sickle Cell Disease Referral Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Aline Malterre
- Pediatric Department, Sickle Cell Disease Referral Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Harry Lezeau
- Pediatric Surgery Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Bassem Khazem
- Laboratory of Hematology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Ekaterina Belozertseva
- Pediatric Department, Sickle Cell Disease Referral Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Eric Guémas
- BIOSSEC Clinical Biostatistics, Paris, France
| | - Ralph Epaud
- Pediatric Department, Sickle Cell Disease Referral Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Paris XII University, INSERM, IMRB, Créteil, France
| | - Serge Pissard
- Genetics Department, Groupe Hospitalo-Universitaire Henri Mondor, INSERM U955, IMRB, Team 2, Paris XII University, Créteil, France
| | - Cécile Arnaud
- Pediatric Department, Sickle Cell Disease Referral Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Corinne Pondarré
- Pediatric Department, Sickle Cell Disease Referral Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- INSERM U955, IMRB, Paris XII University, Créteil, France
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2
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Brousse V, Bernaudin F, Melaine A, Goguillot M, Gallagher M, Benard S, Habibi A. Severity and burden of sickle cell disease in France: a nationwide real-world study. Haematologica 2023; 108:2476-2486. [PMID: 36924235 PMCID: PMC10483347 DOI: 10.3324/haematol.2022.282098] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
The burden of sickle cell disease (SCD) in France has been difficult to apprehend due to the paucity of reliable nationwide epidemiological data. We aimed to describe the epidemiology of SCD and evaluate its burden and costs. Patients with SCD and most severely affected patients were identified between 2012 and 2018 from the French National Health Data System database (SNDS, Système national des données de santé). Outcomes of interest included rates of acute and chronic complications, healthcare resource utilization and associated costs, and were compared in subpopulations of patients before and after hematopoietic stem cell transplantation, initiating hydroxyurea or a chronic transfusion program. Between 2012 and 2018, 22,619 patients with SCD were identified, among which 4,270 patients were defined as most severely affected. Rates of vaso-occlusion episodes and acute chest syndrome were 86.29 (95% confidence interval [CI]: 85.75-86.83] and 12.90 (95% CI: 12.69-13.11) per 100 person years in the study population and 166.9 (95% CI: 165.4- 168.4) and 22.71 (95% CI: 22.16-23.27) per 100 person years in most severely affected patients. Median (Q1-Q3) annualized total costs were €5,073.63 (range, €1,633.74-14,000.94) and €13,295.67 (range, €5,754.67-26,385.23) in the study population and most severely affected patients. Median annualized costs were ten times lower after treatment intensification for hematopoietic stem cell transplantation (€29,011.75 vs. €2,465.98; P<0.001), they slightly decreased after hydroxyurea initiation (€13,057.79 vs. €12,752.44; P=0.003) and were five times higher after chronic transfusion program initiation (€4,643.11 vs. €22,715.85; P<0.001). SCD still places a significant demand on health resources, even after therapeutic intensification.
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Affiliation(s)
- Valentine Brousse
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, F-75019 Paris, France 2. Université Paris Cité and Université des Antilles, Inserm, BIGR, F-75015 Paris
| | - Francoise Bernaudin
- French Referral Center for Sickle Cell Disease; SFGM-TC (Société Française de Greffe de Moelle et de Thérapie Cellulaire); DrepaGreffe Association 20 rue de Coulmiers, 94130 Nogent sur Marne
| | | | | | - Meghan Gallagher
- bluebird bio, Inc., address 455 Grand Union Blvd Somerville, MA, 02145-1446 United States of America
| | | | - Anoosha Habibi
- Sickle Cell Referral Center, Henri Mondor Hospital, AP-HP, UPEC, Laboratory of Excellence GR-Ex, INSERM Unit 955, Mondor Institute of Biomedical Research, Paris-Est Creteil University, Creteil
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3
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Colombatti R, Hegemann I, Medici M, Birkegård C. Systematic Literature Review Shows Gaps in Data on Global Prevalence and Birth Prevalence of Sickle Cell Disease and Sickle Cell Trait: Call for Action to Scale Up and Harmonize Data Collection. J Clin Med 2023; 12:5538. [PMID: 37685604 PMCID: PMC10488271 DOI: 10.3390/jcm12175538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited monogenic disorder with high prevalence throughout sub-Saharan Africa, the Mediterranean basin, the Middle East, and India. Sources of SCD epidemiology remain scarce and fragmented. A systematic literature review (SLR) to identify peer-reviewed studies on SCD epidemiology was performed, with a search of bibliographic databases and key conference proceedings from 1 January 2010 to 25 March 2022 (congress abstracts after 2018). The SLR followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Meta-analyses, using a binomial normal random-effects model, were performed to estimate global and regional prevalence and birth prevalence. Of 1770 journal articles and 468 abstracts screened, 115 publications met the inclusion criteria. Prevalence was highest in Africa (~800/100,000), followed by the Middle East (~200/100,000) and India (~100/100,000), in contrast to ~30/100,000 in Europe. Birth prevalence was highest in Africa (~1000/100,000) and lowest in North America (~50/100,000) and Europe (~30/100,000). This SLR confirmed that sub-Saharan and North-East Africa, India, the Middle East, and the Caribbean islands are global SCD hotspots. Publications including mortality data were sparse, and no conclusions could be drawn about mortality. The identified data were limited due to gaps in the published literature for large parts of the world population; the inconsistent reporting of SCD genotypes, diagnostic criteria, and settings; and a sparsity of peer-reviewed publications from countries with assumed high prevalence. This SLR demonstrated a lack of systematic knowledge and a need to provide uniform data collection on SCD prevalence and mortality.
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Affiliation(s)
- Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Department of Child and Maternal Health, Azienda Ospedaliera, University of Padova, 35122 Padua, Italy
| | | | - Morten Medici
- Novo Nordisk A/S, 2860 Søborg, Denmark; (M.M.); (C.B.)
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4
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Piel FB, Rees DC, DeBaun MR, Nnodu O, Ranque B, Thompson AA, Ware RE, Abboud MR, Abraham A, Ambrose EE, Andemariam B, Colah R, Colombatti R, Conran N, Costa FF, Cronin RM, de Montalembert M, Elion J, Esrick E, Greenway AL, Idris IM, Issom DZ, Jain D, Jordan LC, Kaplan ZS, King AA, Lloyd-Puryear M, Oppong SA, Sharma A, Sung L, Tshilolo L, Wilkie DJ, Ohene-Frempong K. Defining global strategies to improve outcomes in sickle cell disease: a Lancet Haematology Commission. Lancet Haematol 2023; 10:e633-e686. [PMID: 37451304 DOI: 10.1016/s2352-3026(23)00096-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Frédéric B Piel
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - David C Rees
- Department of Paediatric Haematology, King's College London, King's College Hospital, London, UK
| | - Michael R DeBaun
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence for Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Obiageli Nnodu
- Department of Haematology and Blood Transfusion, College of Health Sciences and Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Brigitte Ranque
- Department of Internal Medicine, Georges Pompidou European Hospital, Assistance Publique-Hopitaux de Paris Centre, University of Paris Cité, Paris, France
| | - Alexis A Thompson
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Russell E Ware
- Division of Hematology and Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Miguel R Abboud
- Department of Pediatrics and Adolescent Medicine, and Sickle Cell Program, American University of Beirut, Beirut, Lebanon
| | - Allistair Abraham
- Division of Blood and Marrow Transplantation, Children's National Hospital, Washington, DC, USA
| | - Emmanuela E Ambrose
- Department of Paediatrics and Child Health, Bugando Medical Centre, Mwanza, Tanzania
| | - Biree Andemariam
- New England Sickle Cell Institute, University of Connecticut Health, Connecticut, USA
| | - Roshan Colah
- Department of Haematogenetics, Indian Council of Medical Research National Institute of Immunohaematology, Mumbai, India
| | - Raffaella Colombatti
- Pediatric Oncology Hematology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Nicola Conran
- Department of Clinical Medicine, School of Medical Sciences, Center of Hematology and Hemotherapy (Hemocentro), University of Campinas-UNICAMP, Campinas, Brazil
| | - Fernando F Costa
- Department of Clinical Medicine, School of Medical Sciences, Center of Hematology and Hemotherapy (Hemocentro), University of Campinas-UNICAMP, Campinas, Brazil
| | - Robert M Cronin
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Mariane de Montalembert
- Department of Pediatrics, Necker-Enfants Malades Hospital, Assistance Publique-Hopitaux de Paris Centre, Paris, France
| | - Jacques Elion
- Paris Cité University and University of the Antilles, Inserm, BIGR, Paris, France
| | - Erica Esrick
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Anthea L Greenway
- Department Clinical Haematology, Royal Children's Hospital, Parkville and Department Haematology, Monash Health, Clayton, VIC, Australia
| | - Ibrahim M Idris
- Department of Hematology, Aminu Kano Teaching Hospital/Bayero University Kano, Kano, Nigeria
| | - David-Zacharie Issom
- Department of Business Information Systems, School of Management, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland
| | - Dipty Jain
- Department of Paediatrics, Government Medical College, Nagpur, India
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zane S Kaplan
- Department of Clinical Haematology, Monash Health and Monash University, Melbourne, VIC, Australia
| | - Allison A King
- Departments of Pediatrics and Internal Medicine, Divisions of Pediatric Hematology and Oncology and Hematology, Washington University School of Medicine, St Louis, MO, USA
| | - Michele Lloyd-Puryear
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leon Tshilolo
- Institute of Biomedical Research/CEFA Monkole Hospital Centre and Official University of Mbuji-Mayi, Mbuji-Mayi, Democratic Republic of the Congo
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Kwaku Ohene-Frempong
- Division of Hematology, Children's Hospital of Philadelphia, Pennsylvania, USA; Sickle Cell Foundation of Ghana, Kumasi, Ghana
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Habibi A, Cannas G, Bartolucci P, Voskaridou E, Joseph L, Bernit E, Gellen-Dautremer J, Charneau C, Ngo S, Galactéros F. Outcomes of Pregnancy in Sickle Cell Disease Patients: Results from the Prospective ESCORT-HU Cohort Study. Biomedicines 2023; 11:biomedicines11020597. [PMID: 36831132 PMCID: PMC9953329 DOI: 10.3390/biomedicines11020597] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 02/19/2023] Open
Abstract
Sickle cell disease (SCD) refers to a group of inherited hemoglobin disorders in which sickle red blood cells display altered deformability, leading to a significant burden of acute and chronic complications, such as vaso-occlusive pain crises (VOCs). Hydroxyurea is a major therapeutic agent in adult and pediatric sickle cell patients. This treatment is an alternative to transfusion in some complications. Indeed, it increases hemoglobin F and has an action on the endothelial adhesion of red blood cells, leukocytes, and platelets. Although the safety profile of hydroxyurea (HU) in patients with sickle cell disease has been well established, the existing literature on HU exposure during pregnancy is limited and incomplete. Pregnancy in women with SCD has been identified as a high risk for the mother and fetus due to the increased incidence of maternal and non-fetal complications in various studies and reports. For women on hydroxyurea at the time of pregnancy, transfusion therapy should probably be initiated after pregnancy. In addition, there is still a significant lack of knowledge about the incidence of pregnancy, fetal and maternal outcomes, and management of pregnant women with SCD, making it difficult to advise women or clinicians on outcomes and best practices. Therefore, the objective of this study was to describe pregnancy outcomes (n = 128) reported in the noninterventional European Sickle Cell Disease COhoRT-HydroxyUrea (ES-CORT-HU) study. We believe that our results are important and relevant enough to be shared with the scientific community.
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Affiliation(s)
- Anoosha Habibi
- Sickle Cell Referral Center, Internal Medicine Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, U-PEC, 94000 Créteil, France
- INSERM-U955, Institut Mondor, Université Paris-Est Créteil, Team 2 Transfusion et Maladies du Globule Rouge, Laboratoire d’Excellence GR-Ex, 94000 Créteil, France
- Correspondence:
| | | | - Pablo Bartolucci
- Sickle Cell Referral Center, Internal Medicine Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, U-PEC, 94000 Créteil, France
- INSERM-U955, Institut Mondor, Université Paris-Est Créteil, Team 2 Transfusion et Maladies du Globule Rouge, Laboratoire d’Excellence GR-Ex, 94000 Créteil, France
| | - Ersi Voskaridou
- Thalassemia and Sickle Cell Disease Center, “Laiko” General Hospital, 115 27 Athens, Greece
| | - Laure Joseph
- Biotherapy Department, Necker Children’s Hospital, Assistance Publique-Hôpitaux de Paris, 75610 Paris, France
| | - Emmanuelle Bernit
- Sickle Cell Referral Center, CHU Guadeloupe-Pôle Parents-Enfants—Hôpital Ricou, BP465, Pointe à Pitre, CEDEX, 97159 Guadeloupe, France
| | | | | | | | - Frédéric Galactéros
- Sickle Cell Referral Center, Internal Medicine Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, U-PEC, 94000 Créteil, France
- INSERM-U955, Institut Mondor, Université Paris-Est Créteil, Team 2 Transfusion et Maladies du Globule Rouge, Laboratoire d’Excellence GR-Ex, 94000 Créteil, France
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Mandalaneni K, Venkatapathappa P, Koshy S, Walcott-Bedeau G, Singh V. Transcranial Doppler Ultrasonography-Related Research in the Caribbean Region. Cureus 2023; 15:e35147. [PMID: 36949970 PMCID: PMC10027575 DOI: 10.7759/cureus.35147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 02/20/2023] Open
Abstract
Transcranial Doppler (TCD) ultrasonography is a non-invasive ultrasound technique that uses high-frequency sound waves to measure blood flow velocities in the cerebral vasculature. This review analyzes TCD research in the Caribbean region using a bibliometric analysis of 29 articles from PubMed. The articles were analyzed using Microsoft Excel 2016 and the VOSviewer software (Van Eck and Waltman, Leiden University, Centre for Science and Technology Studies (CWTS), www.vosviewer.com) and characterized various aspects of TCD research, including countries, research themes, authorship, journals, affiliations, and keywords. The majority of the 29 publications came from Cuba (38%), followed by the French West Indies (22%) and Jamaica (20%). Most TCD research focused on sickle cell disease (SCD), accounting for 45% of the studies, followed by 21% of articles on vasospasm and subarachnoid hemorrhage. The use of TCD in brain death and neuro-intensive care was also explored, constituting 17% of the studies. Alternative TCD-monitored treatment options for SCD, such as stem cell transplantation and hydroxyurea, were also frequently investigated. The most productive institutions were Hospital Clínico-Quirúrgico Hermanos Ameijeiras in Havana, Cuba, the Sickle Cell Unit at the University of West Indies (UWI) Mona in Jamaica, the Medical-Surgical Research Center (CIMEQ) in Havana, Cuba, and the SCD Reference Center in Guadeloupe and Martinique in the French West Indies. TCD has been identified as a cost-effective tool for real-time monitoring of cerebral blood flow in many clinical settings, including stroke and SCD, which are prevalent in the Caribbean. Although there is an increase in the trend of using TCD for neuromonitoring in the Caribbean, gaps still exist. Capacity-building initiatives, such as training programs for healthcare providers and the development of local TCD research networks, can improve access to TCD in resource-constrained settings to treat and neuromonitor patients cost-effectively.
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Affiliation(s)
- Kesava Mandalaneni
- Department of Neuroscience, St. George's University School of Medicine, St. George's, GRD
| | | | - Sarah Koshy
- Department of Neuroscience, St. George's University School of Medicine, St. George's, GRD
| | | | - Vajinder Singh
- Department of Pathology, St. George's University School of Medicine, St. George's, GRD
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7
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Colombatti R. Standardizing elements of care in pediatric sickle cell disease centers: The road toward health equity. Pediatr Blood Cancer 2023; 70:e30078. [PMID: 36326131 DOI: 10.1002/pbc.30078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 09/30/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Raffaella Colombatti
- Pediatric Hematology Oncology and Bone Marrow Transplantation Unit, Department of Woman's and Child's Health, University of Padova, Padova, Italy
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8
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Walter O, Cougoul P, Maquet J, Bartolucci P, Lapeyre-Mestre M, Lafaurie M, Moulis G. Risk of vaso-occlusive episode after exposure to corticosteroids in patients with sickle cell disease. Blood 2022; 139:3771-3777. [PMID: 35471555 PMCID: PMC11290598 DOI: 10.1182/blood.2021014473] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/16/2022] [Indexed: 11/20/2022] Open
Abstract
Vaso-occlusive episodes (VOEs) are a major concern in patients with sickle cell disease (SCD). Exposure to systemic corticosteroids has been suspected to increase the occurrence of VOEs in case reports or series. No comparative study has been conducted to investigate this risk, which is still debated. Several clinical trials demonstrated the effectiveness of corticosteroids for the treatment of VOEs, but with increased rates of readmission. The aim of the study was to assess the risk of hospitalization for VOE associated with exposure to systemic corticosteroids in patients with SCD. We used a case-case-time-control design in a nationwide population-based cohort built in the French national health insurance database between 2010 and 2018. The population included all patients with SCD with at least 1 hospitalization for VOE. Corticosteroids were identified using out-of-hospital dispensing data. The outcome was the first hospitalization for VOE. The case-case-time-control design induces self-adjustment for time-invariant confounders, including genotype. Analyses were adjusted for time-dependent confounders (infections, red blood transfusions) and stratified by exposure to hydroxyurea. Overall, 5151 patients were included in the main analysis. Corticosteroid exposure was significantly associated with the occurrence of hospitalizations for VOEs: adjusted odds ratio, 3.8; 95% confidence interval [CI], 2.4-5.6). In patients exposed to hydroxyurea, the adjusted odds ratio was 2.6 (95% CI, 1.1-6.4); it was 4.0 (95% CI, 2.5-6.3) in unexposed patients. These results were consistent in children and adults. In conclusion, systemic corticosteroids were associated to an increased risk of hospitalization for VOEs and should be limited in patients with SCD.
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Affiliation(s)
- Ondine Walter
- CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), and
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
| | - Pierre Cougoul
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
| | - Julien Maquet
- CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), and
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
| | - Pablo Bartolucci
- Department of Internal Medicine, Reference Center of Sickle Cell Disease, Mondor University Hospital, Créteil, France; and
| | - Maryse Lapeyre-Mestre
- CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), and
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Margaux Lafaurie
- CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), and
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Guillaume Moulis
- CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), and
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
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Benefits of a Disease Management Program for Sickle Cell Disease in Germany 2011-2019: The Increased Use of Hydroxyurea Correlates with a Reduced Frequency of Acute Chest Syndrome. J Clin Med 2021; 10:jcm10194543. [PMID: 34640578 PMCID: PMC8509263 DOI: 10.3390/jcm10194543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
Sickle Cell Disease (SCD) is the most common monogenic disorder globally but qualifies as a rare disease in Germany. In 2012, the German Society for Paediatric Oncology and Haematology (GPOH) mandated a consortium of five university hospitals to develop a disease management program for patients with SCD. Besides other activities, this consortium issued treatment guidelines for SCD that strongly favour the use of hydroxyurea and propagated these guidelines in physician and patient education events. In order to quantify the effect of these recommendations, we made use of claims data that were collected by the research institute (WIdO) of the major German insurance company, the Allgemeine Ortskrankenkasse (AOK), and of publicly accessible data collected by the Federal Statistical Office (Statistisches Bundesamt, Destatis). While the number of patients with SCD in Germany increased from approximately 2200 in 2011 to approximately 3200 in 2019, important components of the recently issued treatment guidelines have been largely implemented. Specifically, the use of hydroxyurea has more than doubled, resulting in a proportion of approximately 44% of all patients with SCD being treated with hydroxyurea in 2019. In strong negative correlation with the use of hydroxyurea, the frequency of acute chest syndromes decreased. Similarly, the proportion of patients who required analgesics and hospitals admissions declined. In sum, these data demonstrate an association between the dissemination of treatment guidelines and changes in clinical practice. The close temporal relationship between the increased use of hydroxyurea and the reduction in the incidence of acute chest syndrome in a representative population-based analysis implies that these changes in clinical practice contributed to an improvement in key measures of disease activity.
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MacDonald SE, Palichuk A, Slater L, Tripp H, Reifferscheid L, Burton C. Gaps in knowledge about the vaccine coverage of immunocompromised children: a scoping review. Hum Vaccin Immunother 2021; 18:1-16. [PMID: 34270376 PMCID: PMC8920240 DOI: 10.1080/21645515.2021.1935169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Immunocompromised children are at increased risk of severe illness from vaccine-preventable infections. However, inadequate vaccine coverage remains a concern. This scoping review sought to determine the current state of knowledge regarding vaccine coverage of immunocompromised children. Bibliographic databases were searched for primary research from any year. Data were analyzed quantitatively and narratively. Ninety-seven studies met inclusion criteria. The most commonly studied vaccines were pneumococcal (n = 46), influenza (n = 44), diphtheria/tetanus/pertussis/poliomyelitis/Haemophilus influenzae type B/hepatitis B-containing (n = 36), and measles- and/or mumps- and/or rubella-containing (n = 29). Immunocompromising conditions studied included cancer/stem cell transplants (n = 24), solid organ transplants (n = 23), sickle cell disease (n = 21), immunosuppressive therapy (n = 14), human immunodeficiency virus (n = 12), splenectomy (n = 4), and primary immunodeficiency (n = 2). As more children are treated with immunosuppressive therapies, it is critical to identify whether they are being appropriately vaccinated for age and condition. We identified gaps in the current state of knowledge for specific vaccine types in specific immunocompromised populations.
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Affiliation(s)
| | | | - Linda Slater
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Hailey Tripp
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | - Catherine Burton
- Faculty of Medicine and Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Canada
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Leleu H, Arlet JB, Habibi A, Etienne-Julan M, Khellaf M, Adjibi Y, Pirenne F, Pitel M, Granghaud A, Sinniah C, De Montalembert M, Galacteros F. Epidemiology and disease burden of sickle cell disease in France: A descriptive study based on a French nationwide claim database. PLoS One 2021; 16:e0253986. [PMID: 34242255 PMCID: PMC8270152 DOI: 10.1371/journal.pone.0253986] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Sickle cell disease (SCD) is a severe hematological disorder. The most common acute complication of SCD is vaso-occlusive crisis (VOC), but SCD is a systemic disease potentially involving all organs. SCD prevalence estimates rely mostly on extrapolations from incidence-based newborn screening programs, although recent improvements in survival may have led to an increase in prevalence, and immigration could account for a substantial number of prevalent patients in Europe. The primary objective of this study was to estimate SCD prevalence in France. METHODS A cross-sectional observational study was conducted using a representative sample of national health insurance data. SCD patients followed up in France between 2006 and 2011 were captured through hydroxyurea reimbursement and with the International Classification of Diseases (ICD-10) SCD specific code D570.1.2, excluding code D573 (which corresponds to sickle cell trait (SCT)). Nevertheless, we assumed that ICD-10 diagnosis coding for inpatient stays could be imperfect, with the possibility of SCT being miscoded as SCD. Therefore, prevalence was analyzed in two groups of patients [with at least one (G1) or two (G2) inpatient stay] based on the number of SCD-related inpatient stays in the six-year study period, assuming that SCT patients are rarely rehospitalized compared to SCD. The prevalence of SCD in the sample, which was considered to be representative of the French population, was then extrapolated to the general population. The rate of vaso-occlusive crisis (VOC) events was estimated based on hospitalizations, emergencies, opioid reimbursements, transfusions, and sick leave. RESULTS Based on the number of patients identified for G1 and G2, the 2016 French prevalence was estimated to be between 48.6 per 100,000 (G1) or 32,400 patients and 29.7 per 100,000 (G2) or 19,800 patients. An average of 1.51 VOC events per year were identified, with an increase frequency of 15 to 24 years of age. The average annual number of hospitalizations was between 0.70 (G1) and 1.11 (G2) per patient. Intensive care was observed in 7.6% of VOC-related hospitalizations. Fewer than 34% of SCD patients in our sample received hydroxyurea at any point in their follow-up. The annual average cost of SCD care is €5,528.70 (G1) to €6,643.80 (G2), with most costs arising from hospitalization and lab testing. CONCLUSION Our study estimates SCD prevalence in France at between 19,800 and 32,400 patients in 2016, higher than previously published. This study highlights the significant disease burden associated with vaso-occlusive events.
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Affiliation(s)
| | - Jean Benoit Arlet
- Internal Medicine Department, Sickle Cell Disease National Referral Center, Georges Pompidou European Hospital, Université de Paris, Paris, France
- * E-mail:
| | - Anoosha Habibi
- Sickle Cell Referral Center, Internal Medicine Unit, IMRB Team 2, UPEC, Labex GRex, Henri Mondor Hospital, Créteil, France
| | - Maryse Etienne-Julan
- Referral Center for Sickle Cell Disease, Pointe à Pitre Hospital, Antilles University, Guadeloupe, France
| | - Mehdi Khellaf
- Paris Est University, INSERM U955, APHP, Emergency Department, Henri Mondor Hospital, Créteil, France
| | | | - France Pirenne
- Etablissement Français du sang (EFS), Ile-de-France, Université Paris Est Créteil, Faculté de Médecine Créteil, Créteil, France
- Laboratory of Excellence GRex, INSERM U955, Créteil, France
| | | | | | | | - Mariane De Montalembert
- Department of General Pediatrics and Pediatric Infectious Diseases, Reference Center for Sickle Cell Disease, Necker Hospital for Sick Children, Paris, France
| | - Frédéric Galacteros
- Sickle Cell Referral Center, Internal Medicine Unit, IMRB Team 2, UPEC, Labex GRex, Henri Mondor Hospital, Créteil, France
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12
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Brousse V, Allaf B, Benkerrou M. [Newborn screening for sickle cell disease in France]. Med Sci (Paris) 2021; 37:482-490. [PMID: 34003094 DOI: 10.1051/medsci/2021056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Newborn screening (NBS) for sickle cell disease (SCD) in France has allowed the identification of 9,260 children with SCD since 1989, including 583 in 2019. In mainland France, however, SCD screening is targeted to newborns identified at risk of SCD, i.e born from parents originating from countries with a high SCD prevalence. This screening program, combined to prophylactic measures and a well-organized social and health network in France, has demonstrated considerable efficacy in reducing childhood mortality as well as severe infectious, anemic and neurovascular complications in childhood. SCD NBS has additionally allowed the identification of 180,687 heterozygous (AS) children since 1989. The increasing incidence of SCD (1/1,303 new-borns identified in 2019 versus 1/2,089 in 2009) now pleads for universal NBS and strong advocacy regarding SCD, the most frequent disease identified by NBS in France, and a major public health issue.
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Affiliation(s)
- Valentine Brousse
- Centre de référence de la drépanocytose, Hôpital universitaire Robert Debré, 48 boulevard Sérurier, AP-HP, 75019 Paris, France - Inserm UMRS1134 - Biologie intégrée du globule rouge, 6 rue Alexandre-Cabanel, 75015 Paris, France
| | - Bichr Allaf
- Service de biochimie, Hôpital universitaire Robert Debré, 48 boulevard Sérurier, AP-HP, 75019 Paris, France
| | - Malika Benkerrou
- Centre de référence de la drépanocytose, Hôpital universitaire Robert Debré, 48 boulevard Sérurier, AP-HP, 75019 Paris, France - Inserm UMR 1123-Épidémiologie clinique, évaluation économique appliquées aux populations vulnérables (ECEVE), 10 avenue de Verdun, 75010 Paris, France
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13
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Inati A, Al Alam C, El Ojaimi C, Hamad T, Kanakamedala H, Pilipovic V, Sabah R. Clinical Features and Outcome of Sickle Cell Disease in a Tertiary Center in Northern Lebanon: A Retrospective Cohort Study in a Local, Hospital-Associated Registry. Hemoglobin 2021; 45:80-86. [PMID: 33980108 DOI: 10.1080/03630269.2021.1904974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sickle cell disease affects more than 30 million people worldwide, including 0.1% of the population in Lebanon. It is characterized by unpredictable and painful vaso-occlusive crises (VOCs) that may lead to serious complications. This study describes the clinical burden of sickle cell disease in a cohort of patients treated at a comprehensive sickle cell disease referral center in Tripoli, Northern Lebanon. Patient demographics, clinical events, treatment, and survival were evaluated from a local, hospital-based registry of 334 sickle cell disease patients treated at the Nini Hospital, Tripoli, Lebanon, between 2009 and 2019. Mean age at sickle cell disease diagnosis and at first clinic visit was 2.9 and 8.5 years, respectively. Pain was the most common clinical event observed among all patients. Over the 10-year follow-up period, 15 (4.5%) patients died. Hydroxyurea (HU) and red blood cell (RBC) transfusions were the most commonly used therapies. One hundred and thirty-one (39.0%) patients were diagnosed with sickle cell disease at the Nini Hospital; the remaining patients were referred to and subsequently followed-up at the Nini Hospital. Eighty-seven (66.0%) Nini Hospital-diagnosed patients experienced a VOC. Seventy-four (85.0%) of these patients with a VOC event required HU during follow-up. Patients with a VOC required more RBC transfusions, cholecystectomy, and splenectomy than non-VOC patients. The high disease burden observed in this population of sickle cell disease patients illustrates a continued, unmet need to both prevent and manage VOC events and other sickle cell disease-associated complications.
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Affiliation(s)
- Adlette Inati
- School of Medicine, Lebanese American University, Byblos, Lebanon.,Department of Pediatrics, Nini Hospital, Tripoli, Lebanon
| | - Chadi Al Alam
- Department of Pediatrics, Nini Hospital, Tripoli, Lebanon
| | | | - Taghrid Hamad
- Department of Pediatrics, Nini Hospital, Tripoli, Lebanon
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14
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Dhédin N, Paillard C, Dalle JH, Ouachée M, Buchbinder N, Brissot E, Beguin Y, Masouridi-Levrat S, Yakoub-Agha I, Bernit E, Pondarre C. [Allogeneic hematopoietic stem cell transplant in children and adults with sickle cell disease: Indications and modalities]. Bull Cancer 2020; 107:925-933. [PMID: 32921398 DOI: 10.1016/j.bulcan.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Abstract
Sickle cell disease is associated with severe complications and early mortality in adults. In children, hematopoietic stem cell transplant from HLA-identical sibling can stop the progression of the disease and leads to more than 95% long-term free survival without sickle cell disease. The aim of this workshop was to define indications and modalities of allogeneic hematopoietic stem cell transplant in children and adults with sickle cell disease. Patient and sibling HLA typing should be proposed, early in the course of the disease, when intensification therapies are required. Indications of transplant from HLA-identical sibling in children and adults are, cerebral vasculopathy, occurrence of vaso-occlusive events despite hydroxycarbamide, renal and hepatic diseases related to SCD, chronic anemia<7g/dL despite hydroxycarbamide, need to maintain transfusion programs longer than six months, and major transfusion difficulties related to red blood cell alloimmunization. In children with an HLA-identical sibling donor, we recommend a myeloablative conditioning regimen associating high dose busulfan, cyclophosphamide and ATG, considering the excellent results of this approach In patients over 15 years of age, we recommend the NIH approach consisting of a reduced intensity conditioning regimen by alemtuzumab, and 3Gy total body irradiation, followed by peripheral hematopoietic stem cells and post-transplant immunosuppression by sirolimus In the absence of HLA-identical sibling donor, there is no definitive data for preferring transplant from unrelated versus haplo-identical donors but we recommend to evaluate these approaches in prospective trials.
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Affiliation(s)
- Nathalie Dhédin
- Hôpital Saint-Louis, service d'hématologie adolescents jeunes adultes, Paris, France.
| | - Catherine Paillard
- CHU de Strasbourg, service d'onco-hématologie pédiatrique, Strasbourg, France.
| | - Jean-Hugues Dalle
- Hôpital Robert-Debré, université Paris 7 - Denis Diderot, service d'hémato-immunologie, Paris, France.
| | - Marie Ouachée
- Service de pédiatrie IHOP, 1, place Joseph-Renaut, 69373 Lyon cedex 08, France.
| | | | - Eolia Brissot
- Hôpital Saint-Antoine, Sorbonne université, service d'hématologie et thérapie cellulaire, 184, rue du Faubourg Saint-Antoine, Paris, France.
| | - Yves Beguin
- Université de Liège, CHU de liège, service d'hématologie, 1, avenue de l'Hôpital, 4000 Liège, Belgique.
| | | | - Ibrahim Yakoub-Agha
- Université de Lille, CHU de Lille, Inserm, Infinite, U1286, 59000 Lille, France.
| | - Emmanuelle Bernit
- Assistance publique-Hôpitaux de Marseille, service de médecine interne, Marseille, France.
| | - Corinne Pondarre
- Paris XII université, centre hospitalier intercommunal de Créteil, centre de référence de la drépanocytose, service de pédiatrie, Inserm unité 955, Créteil, France.
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15
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Inusa BPD, Sainati L, MacMahon C, Colombatti R, Casale M, Perrotta S, Rampazzo P, Hemmaway C, Padayachee ST. An Educational Study Promoting the Delivery of Transcranial Doppler Ultrasound Screening in Paediatric Sickle Cell Disease: A European Multi-Centre Perspective. J Clin Med 2019; 9:jcm9010044. [PMID: 31878188 PMCID: PMC7019609 DOI: 10.3390/jcm9010044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Effective stroke prevention in sickle cell disease (SCD) is recommended for children with sickle cell anaemia. Effective implementation relies on the correct stratification of stroke risk using Transcranial Doppler Ultrasound (TCD), prior to committing children to long-term treatment with transfusion. Nevertheless, less than 50% of children with SCD in Europe receive annual TCD—one of the reasons being a lack of trained personnel. The present European multi-centre study was designed to promote the standardisation and delivery of effective screening. Methods: Fifty-five practitioners from differing professional backgrounds were recruited to the TCD training program. The impact of the training programme was evaluated in three European haematology clinics by comparing stroke risk classification and middle cerebral artery time-averaged maximum velocity (TAMMV) obtained from a cohort of 555 patients, before and after training. Results: 42% (23/55) of trainees successfully completed the program. The TAMMV, used to predict stroke risk at each Centre, demonstrated the highest values in Centre 3 (p < 0.0001) before training. The imaging-TCD TAMMV was also higher in Centre 3 (p < 0.001). Following training, the TAMMV showed closer agreement between centres for both imaging-TCD and non-imaging TCD. The stroke risk distribution of children at each centre varied significantly before training (p < 0.001), but improved after training (Fisher’s Exact: no treatment = 5.6, p = 0.41, treatment = 13.8, p < 0.01). The same consistency in stroke risk distribution following training was demonstrated with both non-imaging and imaging-TCD data. Conclusion: The attainment of competency in stroke screening using transcranial Doppler scanning (TCD) in sickle cell disease is more feasible for professionals with an ultrasound imaging background. A quality assurance (QA) system is required to ensure that standards are maintained. Further work is in progress to develop an achievable and reproducible QA program.
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Affiliation(s)
- Baba P. D. Inusa
- Paediatric Haematology Department, Evelina London Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust, St Thomas Street, London SE1 7EH, UK
- Correspondence: ; Tel.: +44-0207-1884676
| | - Laura Sainati
- Clinic of Pediatric Hematology-Oncology, Department of Child and Maternal Health, Azienda Ospedaliera-Università di Padova, Via 8 Febbraio 1848, 2, 35122 Padova, Italy; (L.S.); (R.C.)
| | - Corrina MacMahon
- Paediatric Haematology, Our Lady’s Children’s Hospital, Cooley Rd, Crumlin, D12 N512 Dublin, Ireland;
| | - Raffaella Colombatti
- Clinic of Pediatric Hematology-Oncology, Department of Child and Maternal Health, Azienda Ospedaliera-Università di Padova, Via 8 Febbraio 1848, 2, 35122 Padova, Italy; (L.S.); (R.C.)
| | - Maddalena Casale
- Università degli Studi della Campania, Luigi Vanvitelli, Via Luciano Armanni, 14-20, 80138 Napoli, Italy; (M.C.); (S.P.)
| | - Silverio Perrotta
- Università degli Studi della Campania, Luigi Vanvitelli, Via Luciano Armanni, 14-20, 80138 Napoli, Italy; (M.C.); (S.P.)
| | - Paola Rampazzo
- Department of Neurosciences, Azienda Ospedaliera-Università di Padova, Via 8 Febbraio 1848, 2, 35122 Padova, Italy;
| | - Claire Hemmaway
- Department of Haematology, Queen’s Hospital, Rom Valley Way, Romford RM7 0AG, UK;
| | - Soundrie T. Padayachee
- Ultrasonic Angiology Department, Guy’s & St Thomas’ NHS Foundation Trust, London SE1 9RT, UK;
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Identification of Clinical and Laboratory Parameters Associated with the Development of Acute Chest Syndrome during Vaso-Occlusive Episodes in Children with Sickle Cell Disease: A Preliminary Step before Assessing Specific and Early Treatment Strategies. J Clin Med 2019; 8:jcm8111839. [PMID: 31683997 PMCID: PMC6912589 DOI: 10.3390/jcm8111839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/12/2019] [Accepted: 10/27/2019] [Indexed: 01/01/2023] Open
Abstract
This prospective observational study sought to ascertain clinical and laboratory parameters associated with the development of acute chest syndrome (ACS) during vaso-occlusive episodes (VOE) in children with sickle cell disease (SCD). It was performed at the pediatric department of the university Intercommunal Créteil hospital. All children with SCD (all sickle genotypes) consecutively admitted from November 2013 to December 2016 for painful VOEs and no evidence of ACS were included. Clinical and laboratory parameters collected at admission and within 48 h after admission were compared for children in whom ACS developed or not. Variables that were statistically significant on univariate analysis or considered to be clinically relevant were included in a multivariable model to ascertain the risk factors associated with the development of ACS during a VOE. The variables retained in the multivariate model were used to construct a predictive score for ACS. For each included child and during the study period, only data from the first VOE and/or the first ACS were analyzed. Among 191 hospitalizations for painful VOEs, for 176 children with SCD, ACS developed in 35 during hospitalization. Mean hospital stay was longer for children with ACS versus VOEs alone (7.6 (±2.3) vs. 3.3 (±1.8) days, p < 0.0001), and all children with ACS versus 28/156 (17.9%) with VOEs alone received red blood cell transfusion (p < 0.0001). The multivariate model retained pain score (≥9/10), pain localization (abdominal or spinal pain or involving more than two limbs), and high reticulocyte (≥260 × 109/L) and neutrophil (>10 × 109/L) counts, at admission, as independently associated with ACS development. The area under the receiver operating characteristic curve for the ACS predictive score was 0.82 (95% CI: 0.74–0.89), and the negative predictive value was 97.7%. The evolution profiles during the first 48 h differed between children with ACS and VOEs alone, with a more rapid decline of pain score and leucocytosis in children with VOEs. Clinical and laboratory measurements at admission may be simple parameters to identify children with increased risk of ACS development during VOEs and to facilitate early diagnosis of this respiratory complication. Also, the persistent elevation of leukocyte count on day 2 may be considered a sign of evolving ACS.
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