1Service de Réanimation médico-chirurgicale, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Université Pierre et Marie Curie, Paris, France. 2Service de Médecine interne, Centre de référence de la drépanocytose adulte, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, and Université Pierre et Marie Curie, Paris, France. 3Service d'Hématologie biologique, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Université Pierre et Marie Curie, Paris, France.
Crit Care Med. 2014 Jul;42(7):1629-39. doi: 10.1097/CCM.0000000000000316.
Sickle cell disease is associated with a decreased life expectancy, half of the deaths occurring in the ICU. We aimed to describe the characteristics of sickle cell disease patients admitted to ICU and to identify early predictors of a complicated outcome, defined as the need for vital support or death.
Retrospective observational cohort study of sickle cell disease patients over a 6-year period.
ICU of a French teaching hospital and sickle cell disease referral center.
Hundred thirty-eight ICU admissions in 119 sickle cell disease patients.
None.
ICU admission was mainly indicated for sickle cell disease-related events, especially acute chest syndrome. Mechanical ventilation, vasoactive drugs, and renal replacement therapy were administered to 25 (18%), 10 (7%), and 10 (7%) episodes, respectively. The complicated outcome group (n = 28; 20%) was characterized by a more aggressive acute disease within the 48 hours preceding ICU admission, with a higher respiratory rate, a more frequent acute kidney injury, and a more sustained drop of hemoglobin (all p < 0.01). All nine deaths (7%) were sickle cell disease related. None of the sickle cell disease baseline characteristics predicted accurately a complicated outcome. In multivariate analysis, hemoglobin less than or equal to 7.8 g/dL (odds ratio, 3.6; 95% CI, 1.1-11.9), respiratory rate more than or equal to 32 cycles/min (odds ratio, 5.6; 95% CI, 1.8-17.2), and acute kidney injury on ICU admission (odds ratio, 11.5; 95% CI, 2.5-52.6) were independently associated with a complicated outcome.
Sickle cell disease patients are at high risk of complications when admitted to the ICU. A sustained drop of hemoglobin, acute respiratory distress, and kidney injury at admission are strong predictors of a complicated outcome.
镰状细胞病与预期寿命缩短有关，其中一半的死亡发生在重症监护病房（ICU）。本研究旨在描述 ICU 收治的镰状细胞病患者的特征，并确定复杂结局（需要生命支持或死亡）的早期预测因素。
一项回顾性观察性队列研究，纳入了 6 年内 ICU 收治的镰状细胞病患者。
法国一所教学医院和镰状细胞病转诊中心的 ICU。
119 例镰状细胞病患者共 138 例 ICU 入院。
无。
ICU 入院主要是由于镰状细胞病相关事件，尤其是急性胸痛综合征。25 例（18%）患者接受了机械通气，10 例（7%）患者接受了血管活性药物治疗，10 例（7%）患者接受了肾脏替代治疗。复杂结局组（n=28；20%）的特点是在 ICU 入院前 48 小时内疾病更具侵袭性，呼吸频率更高，急性肾损伤更频繁，血红蛋白持续下降（均 P<0.01）。9 例死亡（7%）均与镰状细胞病相关。镰状细胞病的基线特征均不能准确预测复杂结局。多变量分析显示，血红蛋白≤7.8 g/dL（比值比，3.6；95%置信区间，1.1-11.9）、呼吸频率≥32 次/分（比值比，5.6；95%置信区间，1.8-17.2）和 ICU 入院时急性肾损伤（比值比，11.5；95%置信区间，2.5-52.6）与复杂结局独立相关。
镰状细胞病患者 ICU 入院时并发症风险较高。血红蛋白持续下降、急性呼吸窘迫和入院时的肾脏损伤是复杂结局的强烈预测因素。
