PURPOSE: Patients with Sickle Cell Disease (SCD) are at increased risk of MICU admissions. We sought to determine the diagnoses contributing to MICU admission and the usefulness of the SOFA score in predicting mortality.
METHODS: Clinical data and outcome variables were extracted from the medical records of 58 adult patients with Sickle cell Disease were admitted to the intensive care unit 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. Categorical variables were compared using the Fisher's Exact test. A p value of <0.05 was considered statistically significant.
RESULTS: Of the patients admitted, the genotypic distribution was as follows: 8(14%) HbS Beta-thallasemia; 8 (14%) Hb SC, 39 (67%) HbSS and 3(5%) HbS trait and Alpha-thallasemia. 24 patients (44%) presented with acute chest syndrome (ACS), 6(11%) with acute respiratory failure, 10(18%) with pain crisis, 3(5%) with transfusion reaction and 6(11%) with sepsis unrelated to ACS. The remaining 9 patients presented with cholangitis, multiorgan failure, narcotic overdose, pulmonary embolism, and ischemic stroke requiring TPA. 11 patients (19%) died during ICU admission. Of those, 9 were transferred from the medical floor and 2 were directly admitted from the emergency department (p=0.04). The SOFA score increased from 4.2±2.1 on day of hospital admission to 8.4±1.7 in the non-survivor group on the day of ICU admission (p<0.0001). The SOFA score was 4.5±1.9 in the survivor group; p=0.0001. A SOFA score >8 on day 1 of ICU admission was found to have a sensitivity of 91%, specificity of 93.6% and a NPV of 97.7% of MICU mortality.
CONCLUSION: ACS was the leading diagnosis in patients with SCD admitted to the MICU. A SOFA score > 8 was highly predictive of mortality.
CLINICAL IMPLICATIONS: The SOFA score is a valuable predictor of mortality in patients with SCD admitted to the MICU.
DISCLOSURE: Muhammad Iqbal, None.