Sickle cell disease patients with COVID‐19 in Guadeloupe: Surprisingly favorable outcomes

Abstract

We investigate risk factors for hospitalization and difference between sickle cell syndromes in a cohort of COVID‐19 sickle cell disease (SCD) adult patients managed in the Reference Center of Guadeloupe. We retrospectively collected data of symptomatic SCD adult patients infected with SARS‐CoV‐2 between March and December 2020. Thirty‐eight SCD adult patients with symptomatic COVID‐19 infection were included during the first wave, representing 9.6% of the active patient file at our center. The median age (IQR) was 39 years (24–47). Four patients were obese and two had moderate renal failure. The median duration of symptoms (IQR) was 10 days (5–15). Seventeen (44.7%) patients were hospitalized, including two in intensive care unit (ICU) for acute chest syndrome. An 85‐year‐old SC patient with prostate cancer died. No difference was detected between inpatient and outpatient groups in terms of age, gender, BMI, SCD clinical complications, and in history SCD treatment. There was no difference for severity, hospitalization, length of stay, ICU stay, or death between SS or Sβ°‐thal patients and SC or Sβ + ‐thal patients. These overall favorable outcomes among symptomatic patients may be related to the low prevalence of comorbidity known to be linked to the more severe forms of COVID‐19, but also to the prompt coordinated management of SCD patients in the Reference Center.

Demographics and outcomes of hemoglobin genotype in hospitalized patients with COVID‐19 and sickle cell disease in the United States

“…HbSβ + ). 12 However, in a study by Bernit et al, 13 there was no signifi- Patients with HbSS are more prone to hemolysis and severe anemia; 16 The increased odds of in-hospital mortality with shock and vasopressor use in our study are consistent with the findings in a meta-analysis where higher in-hospital mortality, 30-day mortality, and frequency of acute kidney injury were associated with vasopressors used in the management of shock in critically ill patients with COVID-19. 22 Putative reasons for increased mortality risk include vasopressors' complex multi-systemic biologic effects, which may adversely affect survival.…”

“…[10][11][12] Another study found no significant difference in outcomes among the Hb genotypes. 13 These studies were, however, of small sample sizes and limited in statistical power. Using a nationally representative database, we aim to explore if any association exists between COVID-19 outcomes and Hb genotype.…”

“…Few studies have examined this association in patients with SCD and COVID‐19, and most of them reported worse outcomes with HbSC and sickle cell‐beta thalassemia (HbSβ) compared to HbSS 10–12 . Another study found no significant difference in outcomes among the Hb genotypes 13 . These studies were, however, of small sample sizes and limited in statistical power.…”

COVID-19 and Sickle Cell Disease: Two Independent Risk Factors for Venous Thromboembolism

“…The pre-existing state of hypoxia, oxidative stress, and chronic inflammation associated with SCD may be associated with the milder phenotype observed in some studies [53][54][55].…”

“…A recent meta-analysis by Hoogenboom et al (2022), which pooled data from 71 studies, found that SCD patients have a mild-moderate COVID-19 disease course, a two-seven-fold increase in hospitalizations, and a 1.2-fold increase in the risk of death; but when matched with controls with similar comorbidities and end-organ damage, the risks are usually equal [ 52 ]. The pre-existing state of hypoxia, oxidative stress, and chronic inflammation associated with SCD may be associated with the milder phenotype observed in some studies [ 53 - 55 ].…”