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Score Predicting Acute Chest Syndrome During Vaso-occlusive Crises in Adult Sickle-cell Disease Patients.

Abstract

BACKGROUND

Vaso-occlusive crisis (VOC), hallmark of sickle-cell disease (SCD), is the first cause of patients' Emergency-Room admissions and hospitalizations. Acute chest syndrome (ACS), a life-threatening complication, can occur during VOC, be fatal and prolong hospitalization. No predictive factor identifies VOC patients who will develop secondary ACS.

METHODS

This prospective, monocenter, observational study on SS/S-β0thalassemia SCD adults aimed to identify parameters predicting ACS at Emergency-Department arrival. The primary endpoint was ACS onset within 15days of admission. Secondary endpoints were hospitalization duration, morphine consumption, pain evaluation, blood transfusion(s) (BT(s)), requiring intensive care and mortality.

FINDINGS

Among 250 VOCs included, 247 were analyzed. Forty-four (17.8%) ACSs occurred within 15 (median [IQR] 3 [2, 3]) days post-admission based on auscultation abnormalities; missing chest radiographs excluded three patients. Comparing ACS to VOC, respectively, median hospital stay was longer 9 [7-11] vs 4 [3-7] days (p<0.0001), 7/41 (17%) vs 1/203 (0.5%) required intensive care (p<0.0001), and 20/41 (48.7%) vs 6/203 (3%) required BTs (p<0.0001). No patient died. The multivariate model retained reticulocyte and leukocyte counts, and spine and/or pelvis pain as being independently associated with ACS; the resulting ACS-predictive score's area under the ROC was 0.840 [95% CI 0.780-0.900], 98.8% negative-predictive value and 39.5% positive-predictive value for the real ACS incidence.

INTERPRETATION

The ACS-predictive score is simple, easily applied and could change VOC management and therapeutic perspectives. Assessed ACS risk could lead to earlier discharges or close monitoring and rapid medical intensification to prevent ACS.

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  • Authors+Show Affiliations

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    IMRB, Henri-Mondor Hospital-UPEC, Créteil, France; Department of Internal Medicine, Henri-Mondor Hospital-UPEC, Créteil, France. Electronic address: pablo.bartolucci@aphp.fr.

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    IMRB, Henri-Mondor Hospital-UPEC, Créteil, France; Department of Internal Medicine, Henri-Mondor Hospital-UPEC, Créteil, France.

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    Department of Internal Medicine, Henri-Mondor Hospital-UPEC, Créteil, France.

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    Clinical Research Unit, Department of Public Health, Henri-Mondor Hospital-UPEC, Créteil, France.

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    Department of Immunology, Henri-Mondor Hospital-UPEC, Créteil, France.

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    Department of Immunology, Henri-Mondor Hospital-UPEC, Créteil, France.

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    Department of Biochemistry, Henri-Mondor Hospital-UPEC, Créteil, France.

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    Department of Biochemistry, Henri-Mondor Hospital-UPEC, Créteil, France.

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    Department of Hematology and Immunology, Henri-Mondor Hospital-UPEC, Créteil, France.

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    Sickle Cell Referral Center, Henri-Mondor Hospital-UPEC, Créteil, France.

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    Emergency Department, Henri-Mondor Hospital-UPEC, Créteil, France.

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    Department of Internal Medicine, Henri-Mondor Hospital-UPEC, Créteil, France.

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    Emergency Department, Henri-Mondor Hospital-UPEC, Créteil, France.

    ,

    IMRB, Henri-Mondor Hospital-UPEC, Créteil, France.

    ,

    IMRB, Henri-Mondor Hospital-UPEC, Créteil, France; Department of Internal Medicine, Henri-Mondor Hospital-UPEC, Créteil, France.

    Department of Internal Medicine, Henri-Mondor Hospital-UPEC, Créteil, France.

    Source

    EBioMedicine 10: 2016 Aug pg 305-11

    MeSH

    Acute Chest Syndrome
    Adult
    Anemia, Sickle Cell
    Chest Pain
    Comorbidity
    Emergency Service, Hospital
    Female
    Humans
    Male
    Outcome Assessment (Health Care)
    Patient Admission
    Prognosis
    Prospective Studies
    Radiography, Thoracic
    Risk Factors
    Severity of Illness Index
    Young Adult

    Pub Type(s)

    Journal Article
    Observational Study

    Language

    eng

    PubMed ID

    27412264

    Citation

    Bartolucci, Pablo, et al. "Score Predicting Acute Chest Syndrome During Vaso-occlusive Crises in Adult Sickle-cell Disease Patients." EBioMedicine, vol. 10, 2016, pp. 305-11.
    Bartolucci P, Habibi A, Khellaf M, et al. Score Predicting Acute Chest Syndrome During Vaso-occlusive Crises in Adult Sickle-cell Disease Patients. EBioMedicine. 2016;10:305-11.
    Bartolucci, P., Habibi, A., Khellaf, M., Roudot-Thoraval, F., Melica, G., Lascaux, A. S., ... Godeau, B. (2016). Score Predicting Acute Chest Syndrome During Vaso-occlusive Crises in Adult Sickle-cell Disease Patients. EBioMedicine, 10, pp. 305-11. doi:10.1016/j.ebiom.2016.06.038.
    Bartolucci P, et al. Score Predicting Acute Chest Syndrome During Vaso-occlusive Crises in Adult Sickle-cell Disease Patients. EBioMedicine. 2016;10:305-11. PubMed PMID: 27412264.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Score Predicting Acute Chest Syndrome During Vaso-occlusive Crises in Adult Sickle-cell Disease Patients. AU - Bartolucci,Pablo, AU - Habibi,Anoosha, AU - Khellaf,Mehdi, AU - Roudot-Thoraval,Françoise, AU - Melica,Giovanna, AU - Lascaux,Anne-Sophie, AU - Moutereau,Stéphane, AU - Loric,Sylvain, AU - Wagner-Ballon,Orianne, AU - Berkenou,Jugurtha, AU - Santin,Aline, AU - Michel,Marc, AU - Renaud,Bertrand, AU - Lévy,Yves, AU - Galactéros,Frédéric, AU - Godeau,Bertrand, Y1 - 2016/06/29/ PY - 2016/04/05/received PY - 2016/06/14/revised PY - 2016/06/27/accepted PY - 2016/7/15/entrez PY - 2016/7/15/pubmed PY - 2017/2/15/medline KW - Acute chest syndrome KW - Prospective study KW - Score KW - Sickle cell disease KW - Vaso-occlusive crisis SP - 305 EP - 11 JF - EBioMedicine JO - EBioMedicine VL - 10 N2 - BACKGROUND: Vaso-occlusive crisis (VOC), hallmark of sickle-cell disease (SCD), is the first cause of patients' Emergency-Room admissions and hospitalizations. Acute chest syndrome (ACS), a life-threatening complication, can occur during VOC, be fatal and prolong hospitalization. No predictive factor identifies VOC patients who will develop secondary ACS. METHODS: This prospective, monocenter, observational study on SS/S-β0thalassemia SCD adults aimed to identify parameters predicting ACS at Emergency-Department arrival. The primary endpoint was ACS onset within 15days of admission. Secondary endpoints were hospitalization duration, morphine consumption, pain evaluation, blood transfusion(s) (BT(s)), requiring intensive care and mortality. FINDINGS: Among 250 VOCs included, 247 were analyzed. Forty-four (17.8%) ACSs occurred within 15 (median [IQR] 3 [2, 3]) days post-admission based on auscultation abnormalities; missing chest radiographs excluded three patients. Comparing ACS to VOC, respectively, median hospital stay was longer 9 [7-11] vs 4 [3-7] days (p<0.0001), 7/41 (17%) vs 1/203 (0.5%) required intensive care (p<0.0001), and 20/41 (48.7%) vs 6/203 (3%) required BTs (p<0.0001). No patient died. The multivariate model retained reticulocyte and leukocyte counts, and spine and/or pelvis pain as being independently associated with ACS; the resulting ACS-predictive score's area under the ROC was 0.840 [95% CI 0.780-0.900], 98.8% negative-predictive value and 39.5% positive-predictive value for the real ACS incidence. INTERPRETATION: The ACS-predictive score is simple, easily applied and could change VOC management and therapeutic perspectives. Assessed ACS risk could lead to earlier discharges or close monitoring and rapid medical intensification to prevent ACS. SN - 2352-3964 UR - https://www.unboundmedicine.com/medline/citation/27412264/Score_Predicting_Acute_Chest_Syndrome_During_Vaso_occlusive_Crises_in_Adult_Sickle_cell_Disease_Patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2352-3964(16)30296-1 DB - PRIME DP - Unbound Medicine ER -