PURPOSE: We reviewed hematologic parameters in sickle cell patients admitted to the medical intensive care unit (MICU), in order to predict poor outcome.
METHODS: Clinical data and outcome variables were extracted from the medical records of 58 adult patients with Sickle cell Disease who were admitted to the MICU at Kings County Hospital from November 2005 until December 2007. Data are presented as mean ± SD. Comparisons between groups were done using the Student t-test or the Wilcoxon test for continuous variables as indicated. Categorical variables were compared using the Fisher's Exact test. A p-value of <0.05 was considered statistically significant. A simple evolving disseminated intravascular coagulation (DIC) score that awarded 1 point for each of the following: a) an absolute platelet count <100 × 109/L; b) prothrombin time >15.0 secs; c) 20% decrease in platelets; and d) >0.3-sec increase in prothrombin time, was used to assess outcomes.
RESULTS: 11 patients (19%) died during MICU admission. Mortality was associated with lower steady state fetal hemoglobin, lower corrected WBC on hospital admission day and on MICU day 3. Higher steady state and admission hemoglobin, and a larger drop in hemoglobin on MICU day 3 from admission, was also apparent in the non-survivors (3.6±2.3 vs. 0.6±2.1; p=0.009). Non-survivors had lower reticulocyte count on admission day and on MICU day 3. Total bilirubin was lower on day 1 in the non-survivors. LDH was not significantly different between the two groups on day of MICU admission. There was marked elevation in LDH on MICU day 3 in the non-survivors (Table-1). Mortality was associated with DIC score of ≥3 (78% vs. 15%; p=0.0006). HbSBeta-thal and HbSC patients had higher mortality than HbSS patients (50%, 37%, and 8% respectively; p=0.006).
CONCLUSION: Mortality was increased in patients with SCD presenting with evidence of bone marrow unresponsiveness and DIC.
CLINICAL IMPLICATIONS: Inadequate bone marrow response and DIC are important indicators of poor outcome in critically ill sickle cell patients.
DISCLOSURE: Olumayowa Abe, None.