University of Central Florida College of Medicine, Graduate Medical Education/HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL, USA.
King Edward Medical University, Lahore, Punjab, Pakistan.
Ann Hematol. 2023 Jul;102(7):1669-1676. doi: 10.1007/s00277-023-05275-6. Epub 2023 May 30.
Vaso-occlusive pain crisis is a debilitating complication of sickle cell disease (SCD) and it is the most common cause of hospitalization among these individuals. We studied the inpatient outcomes among patients admitted with sickle cell crisis based on the timing of red blood cell transfusion. In this retrospective study, we used the United States National Inpatient Sample (NIS) data for the year 2019, to identify adult patients hospitalized with the principal diagnosis of sickle cell crisis who received simple red blood cell transfusion during their hospitalization. Patients were divided into two groups. Those who received simple red cell transfusion within 24 hours of admission were classified as early transfusion. After adjusting for confounders, the mean adjusted length of stay for patients with early transfusion was significantly lower than those who received a late blood transfusion by 3.51 days (p-value < 0.001) along with a decrease in mean adjusted hospitalization charges and cost, by 25,487 and 4,505 United States Dollar (USD) respectively. The early red cell transfusion was also associated with a decrease in inpatient mortality, demonstrated by an adjusted odds ratio (aOR) of 0.19 (p-value 0.036), and a reduction in in-hospital sepsis, with an aOR of 0.28 (p-value < 0.001), however, no statistically significant difference was found between the two groups regarding acute respiratory failure requiring intubation, vasopressors requirement, acute kidney injury requiring dialysis and intensive care unit (ICU) admission. We recommend timely triage and reassessment to identify sickle cell crisis patients requiring blood transfusion. This intervention can notably affect the inpatient length of stay, resource utilization, and hospitalization outcomes.
血管阻塞性疼痛危象是镰状细胞病（SCD）的一种使人虚弱的并发症，也是此类患者住院的最常见原因。我们根据红细胞输注的时间，研究了因镰状细胞危象住院患者的住院结局。在这项回顾性研究中，我们使用了 2019 年美国国家住院患者样本（NIS）的数据，以确定因主要诊断为镰状细胞危象而住院并在住院期间接受单纯红细胞输注的成年患者。患者分为两组。在入院 24 小时内接受单纯红细胞输注的患者被归类为早期输血。在调整混杂因素后，早期输血患者的平均调整住院时间比晚期输血患者显著缩短 3.51 天（p 值 < 0.001），平均调整住院费用和成本分别降低 25487 美元和 4505 美元。早期红细胞输注还与住院死亡率降低相关，调整后的比值比（aOR）为 0.19（p 值为 0.036），与住院期间发生脓毒症的风险降低相关，aOR 为 0.28（p 值 < 0.001），但两组在需要插管的急性呼吸衰竭、需要血管加压药、需要透析的急性肾损伤和入住重症监护病房（ICU）方面无统计学差异。我们建议及时进行分诊和重新评估，以确定需要输血的镰状细胞危象患者。这种干预措施可以显著影响住院患者的住院时间、资源利用和住院结局。
