Trends in Hospitalizations for Sickle Cell Disease Related-Complications in USA 2004 - 2012

Abstract

Background: Sickle cell disease (SCD) affects 100,000 patients in the USA. However, no recent data was available for annual national trends in hospitalization rates, in-hospital mortality, hospital length of stay (LOS) and costs of SCD admissions due to its complications. Methods:This study was conducted to study the trends of hospitalization rates, in-hospital mortality, LOS and hospital charges due to SCD-related complications in African American (AA) patients from 2004 to 2012 in the USA. Complications included acute chest syndrome, splenic sequestration, bacterial pneumonia, sepsis, stroke, deep vein thrombosis (DVT) or pulmonary embolism, retinal circulation complications, priapism, disorders related to biliary stones, or those required blood transfusions. We obtained the study population from the Nationwide Inpatient Sample.

Prevalence and outcomes of pulmonary embolism with sickle cell disease: Analysis of the Nationwide Inpatient Sample, 2016–2020

“…The relatively stable prevalence of hospitalizations of PE with SCD in our analysis is in agreement with the findings of a previous study that examined trends in the rates of admission of SCD‐related complications, including PE, between 2004 and 2012 10 . Disease‐modifying medications have been associated with significant reductions in hypercoagulability markers in SCD, and whether this may account for the observed stable incidence of PE in SCD in our cohort requires further studies to examine this relationship 13 …”

“…Our finding of higher rates of PE with SCD in females contradict the reports of previous limited population studies, which did not find significant gender difference. However, there was a preponderance of females in the cohort of PE with SCD in those studies 10,13 . The sample size of our cohort is larger and drawn from a nationally representative sample.…”

“…PE is often missed or delayed in the SCD population due to the challenges of differentiating it from other acute SCD‐related complications, such as ACS. In addition, because of the low rate of positive imaging in SCD, fewer chest computerized tomographic (CT) scans are performed in them 9,10,19,20 . Whether these factors contribute to the higher mortality in patients with SCD remains to be determined.…”

“…Activation of the coagulation cascade among these patients has been attributed to elevated whole blood thrombin, depleted natural anticoagulants, and increased tissue factor expression on blood monocytes 8 . Studies have identified that PE is higher in hospitalized patients with SCD than in the general population; in addition, the annual incidence initially increased but then began to decline 9,10 . However, there is a lack of nationally representative data to examine the trends of hospitalization and outcomes of PE in patients with SCD, particularly in the last decade.…”

Common Complications of Sickle Cell Disease: A Simulation-Based Curriculum

“…10 Our curriculum is based on three case vignettes highlighting common causes of morbidity and mortality in SCD: septic shock, acute chest syndrome (ACS), and strokes. First, sepsis is a major cause of hospitalization 11 in SCD and infection risk is increased due to immune defects including functional or surgical asplenia. The risk of and mortality from sepsis in asplenic patients is two-to threefold higher when compared to the general population.…”