Background
Methods
Study population
Patient management
Data collection and outcome definition
Lung ultrasound
Lung inspiratory vital capacity measurement
Statistical analysis
Results
Patient characteristics
Patients characteristics | All patients (n = 56) | Patients with |
p
| |
---|---|---|---|---|
Favourable outcome | Complicated outcome | |||
(n = 42) | (n = 14) | |||
Demographic data, median [IQR] | ||||
Sex ratio (M/F) | 22/34 | 17/25 | 5/9 | 0.75 |
Age (years) | 26.4 [21.7–29.8] | 27.4 [22.3–31.5] | 22.1 [20.7–26.8] | 0.06 |
BMI (kg/m2) | 21.3 [19.8–23.6] | 21.7 [19.8–23.4] | 20.8 [20.2–24.7] | 0.78 |
Cause of hospital admission, % (n) | ||||
Vaso-occlusive crisis | 48% (27) | 52% (32) | 43% (6) | 0.34 |
Acute chest syndrome | 46% (26) | 45% (19) | 50% (7) | |
Others | 6% (3) | 2% (1) | 7% (1) | |
Type of hemoglobinopathy, % (n) | ||||
SS | 93% (52) | 90% (38) | 100% (14) | 0.23 |
SC | 7% (4) | 10% (4) | – | |
Baseline Hb (g/dL), median [IQR] | 8.5 [7.5–9.5] | 8.7 [7.8–9.5] | 7.5 [7–9] | 0.08 |
Number of vaso-occlusive crises/year, % (n) | ||||
0 | 7% (4) | 5% (2) | 14% (2) | 0.47 |
1–3 | 70% (39) | 74% (31) | 57% (8) | |
4–6 | 21% (12) | 19% (8) | 29% (4) | |
> 6 | 2% (1) | 2% (1) | 0% (0) | |
Sickle cell disease-related complication, % (n) | ||||
Previous acute chest syndrome | 73% (41) | 74% (31) | 71% (10) | 0.86 |
1–2 |
34% (19)
|
31% (13)
|
43% (6)
| 0.55 |
3–4 |
25% (14)
|
26% (11)
|
21% (3)
| |
> 4 |
14% (8)
|
17% (7)
|
7% (1)
| |
Cholecystectomy | 35% (19) | 26% (11) | 57% (8) | 0.03 |
Non-septic osteonecrosis | 24% (14) | 24% (10) | 29% (4) | 0.72 |
Renal injury | 22% (12) | 26% (11) | 7% (1) | 0.13 |
Retinopathy | 20% (12) | 21% (9) | 21% (3) | 1.00 |
Priapism | 7% (4) | 10% (4) | 0% (0) | 0.23 |
Others | 15% (8) | 14% (6) | 14% (2) | 1.00 |
Clinical severity score of Hebbel, median [IQR] | 6 [3–9] | 6 [3–9] | 5.5 [3–8] | 0.97 |
Patient characteristics | All patients (n = 56) | Patients with |
p
| |
---|---|---|---|---|
Favourable outcome | Complicated outcome | |||
(n = 42) | (n = 14) | |||
Acute chest syndrome symptoms, % (n) | ||||
Cough | 70% (39) | 69% (29) | 71% (10) | 0.17 |
Expectoration | 50% (28) | 52% (22) | 43% (6) | 0.54 |
Acute dyspnea | 82% (46) | 86% (36) | 71% (10) | 0.23 |
Mild |
35% (16/46)
|
33% (12/36)
|
40% (4/10)
| 0.24 |
Moderate |
41% (19/46)
|
47% (17/36)
|
20% (2/10)
| |
Severe |
24% (11/46)
|
19% (7/36)
|
40% (4/10)
| |
Fever | 84% (47) | 83% (35) | 86% (12) | 0.83 |
Pulmonary rales | 95% (53) | 95% (40) | 93% (13) | 0.73 |
Crackling sounds |
75% (40/53)
|
78% (31/40)
|
69% (9/13)
| |
Acute chest pain | 93% (52) | 93% (39) | 93% (13) | 1.00 |
Numeric pain scale value | 7 [6–9] | 8 [6–9] | 7 [5.3–8.5] | 0.39 |
Other pain | 68% (38) | 67% (28) | 71% (10) | 0.74 |
Arms and/or legs |
48% (27)
|
45% (19)
|
57% (8)
| 0.36 |
Back |
23% (13)
|
24% (10)
|
21% (3)
| |
Abdomen |
9% (5)
|
7% (3)
|
14% (2)
| |
Head and neck |
5% (3)
|
5% (2)
|
7% (1)
| |
Clinical characteristics, median [IQR] | ||||
Heart rate (/min) | 100 [87–111] | 99 [86- 111] | 102 [88–113] | 0.73 |
Systolic blood pressure (mmHg) | 130 [115–139] | 130 [112–140] | 125 [122–138] | 0.93 |
Diastolic blood pressure (mmHg) | 65 [59–75] | 68 [59–75] | 63 [61–69] | 0.79 |
Respiratory rate (/min) | 24 [20–29] | 23 [20–29] | 27 [23–31] | 0.16 |
Inspiratory vital capacity (mL) | 1000 [600–1250] | 1000 [600–1300] | 750 [500–1100] | 0.12 |
SOFA score (points) | 4 [3–4] | 3 [3–4] | 4 [3–4] | 0.30 |
SAPS II (points) | 15 [10.5–17] | 14 [10–17] | 16 [13–18] | 0.32 |
Laboratory values, median [IQR]a | ||||
Haemoglobin (g/dL) | 7.5 [6.9–8.5] | 7.5 [6.9–8.7] | 7.4 [6.5–7.8] | 0.18 |
Haemoglobin S (%) | 81 [61–88] | 80 [57–87] | 83 [76–88] | 0.21 |
Platelets (G/L) | 327 [298–403] | 329 [264–403] | 325 [294–434] | 0.76 |
Lactate dehydrogenase (UI/L) | 544 [420–745] | 503 [403–715] | 613 [525–834] | 0.09 |
Total bilirubin (µmol/L) | 47 [33–79] | 55 [38–79] | 36 [29–44] | 0.06 |
Aspartate aminotranferase (UI/L) | 58 [36–73] | 53 [38–69] | 69 [35–77] | 0.56 |
Alanine aminotransferase (UI/L) | 33 [18–52] | 32 [18- 49] | 35 [18–51] | 0.87 |
Blood gas results, median [IQR]b | ||||
pH | 7.39 [7.36–7.41] | 7.39 [7.36–7.41] | 7.38 [7.35–7.42] | 0.71 |
PaO2 (mmHg) | 81 [62–100] | 80 [57–93] | 96 [72–102] | 0.18 |
With delivered O2 flow (L/min) | 3 [2–4.5] | 3 [2–4.8] | 3 [2–4] | |
PaO2/FiO2 ratio (mmHg) | 259 [217–302] | 254 [214–277] | 300 [229–317] | 0.19 |
PaCO2 (mmHg) | 44 [40–48] | 43 [41–48] | 47 [39–49] | 0.54 |
SaO2 (%) | 95 [93–97.2] | 95 [90–97] | 97 [93.9–97.6] | 0.27 |
Clinico-biological data
Data course and outcomes | All patients (n = 56) | Patients with |
p
| |
---|---|---|---|---|
Favourable outcome | Complicated outcome | |||
(n = 42) | (n = 14) | |||
Oxygen delivery (L/min), median [IQR] | ||||
Mean O2 flow at D0 | 3.2 [2.3 to 4.5] | 3.2 [2.3 to 4.3] | 3.6 [2.6 to 4.9] | 0.54 |
Mean O2 flow change at D2a | − 0.9 [− 2.4 to − 0.1] | − 1 [− 2.4 to − 0.2] | − 0.6 [− 1.3 to 0] | 0.53 |
Numeric Pain Scale values, median [IQR] | ||||
Mean NPS at D0 | 4 [2.4 to 6] | 3.9 [2 to 6] | 4.2 [3.9 to 6.3] | 0.23 |
Mean NPS change at D2a | − 1.7 [− 3.5 to − 0.6] | − 1.7 [− 3.6 to − 0.8] | − 1.3 [− 3.4 to 0.1] | 0.33 |
Respiratory rate (/min), median [IQR] | ||||
Respiratory rate at D0 | 24 [20 to 29] | 23 [20 to 29] | 27 [23 to 31] | 0.16 |
Respiratory rate change at D2a | − 5 [− 7 to − 1.5] | − 5 [− 7 to − 0.5] | − 4 [− 6 to − 2.8] | 0.70 |
Laboratory values, median [IQR] | ||||
Haemoglobin at D0 (g/dL) | 7.5 [6.9 to 8.5] | 7.5 [6.9 to 8.7] | 7.4 [6.5 to 7.8] | 0.18 |
Haemoglobin change at D2 (g/dL)a | + 0.2 [− 0.6 to 1.5] | + 0.1 [− 0.6 to 0.6] | + 0.9 [− 0.1 to 1.5] | 0.03 |
Platelets at D0 (G/L) | 327 [298 to 403] | 329 [264 to 403] | 325 [294 to 434] | 0.76 |
Platelets change at D2 (G/L)a | + 18 [− 18 to 23] | + 26 [0 to 74] | − 2 [− 34 to 38] | 0.08 |
LDH at D0 (UI/L) | 544 [420 to 745] | 503 [403 to 715] | 613 [525 to 834] | 0.09 |
LDH change at D2 (UI/L)a | − 47 [− 153 to − 7] | − 58 [− 145 to − 18] | − 24 [− 205 to 90] | 0.44 |
Bilirubin at D0 (µmol/L) | 47 [33 to 79] | 55 [38 to 79] | 36 [29 to 44] | 0.06 |
Bilirubin change at D2 (µmol/L)a | − 12 [− 29 to − 6] | − 15 [− 35 to − 6] | − 9 [− 12 to − 3] | 0.10 |
SOFA score (points), median [IQR] | ||||
SOFA score at D0 | 4 [3 to 4] | 3 [3 to 4] | 4 [3 to 4] | 0.30 |
SOFA score change at D2a | − 1 [− 1 to 0] | − 1 [− 1 to − 1] | − 0.5 [− 1 to 0] | 0.09 |
Lung ultrasound data, median [IQR] | ||||
LU score at D0 | 24 [20 to 28] | 25 [20 to 28] | 22.5 [18 to 26] | 0.17 |
LU score change at D2a | − 5 [− 11 to 1] | − 7 [− 12 to − 5] | + 2 [− 2.5 to 5] | < 0.001 |
LU re-aeration score between D2 and D0a | 5 [− 3 to 10.5] | 7.5 [4.5 to 15] | − 3 [− 6.5 to 1.8] | < 0.001 |
Inspiratory vital capacity (mL), median [IQR] | ||||
Inspiratory vital capacity at D0 | 1000 [600 to 1250] | 1000 [600 to 1300] | 750 [500 to 1100] | 0.12 |
Inspiratory vital capacity change at D2a | + 250 [25 to 500] | + 500 [150 to 600] | + 250 [0 to 250] | 0.01 |
Empirical antimicrobial therapy, % (n) | 98% (55) | 98% (41) | 100% (14) | 0.56 |
Microbiologically documented pneumonia, % (n) | 20% (11) | 21% (9) | 14% (2) | 0.71 |
Transfusion, % (n) or median [IQR] | ||||
Transfusion | 57% (32) | 45% (19) | 93% (13) | 0.005 |
Total number of RBC units | 1 [0 to 2] | 0 [0 to 2] | 2 [2 to 3] | < 0.001 |
Mechanical ventilation, % (n) | ||||
Non-invasive | 2% (1) | 0% (0) | 7% (1) | 0.02 |
Invasive | 2% (1) | 0% (0) | 7% (1) | |
Length-of-stay (days), median [IQR] | ||||
ICU | 5 [4 to 6] | 4 [4 to 5] | 7 [7 to 8] | – |
Hospital | 8 [6 to 11.3] | 7 [5 to 9] | 13 [10.3 to 14] | < 0.001 |
Death, % (n) | 0% (0) | 0% (0) | 0% (0) | – |