title: Associated risk factors for silent cerebral infarcts in sickle cell anemia: low baseline hemoglobin, sex, and relative high systolic blood pressure.
abstract: The most common form of neurologic injury in sickle cell anemia (SCA) is silent cerebral infarction (SCI). In the Silent Cerebral Infarct Multi-Center Clinical Trial, we sought to identify risk factors associated with SCI. In this cross-sectional study, we evaluated the clinical history and baseline laboratory values and performed magnetic resonance imaging of the brain in participants with SCA (HbSS or HbSβ° thalassemia) between the ages of 5 and 15 years with no history of overt stroke or seizures. Neuroradiology and neurology committees adjudicated the presence of SCI. SCIs were diagnosed in 30.8% (251 of 814) participants who completed all evaluations and had valid data on all prespecified demographic and clinical covariates. The mean age of the participants was 9.1 years, with 413 males (50.7%). In a multivariable logistic regression analysis, lower baseline hemoglobin concentration (P < .001), higher baseline systolic blood pressure (P = .018), and male sex (P = .030) were statistically significantly associated with an increased risk of an SCI. Hemoglobin concentration and systolic blood pressure are risk factors for SCI in children with SCA and may be therapeutic targets for decreasing the risk of SCI. This study is registered at www.clinicaltrials.gov as #NCT00072761.
authors.affiliation: Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, USA. m.debaun@vanderbilt.edu
authors.forename: Michael R
authors.initials: MR
authors.lastname: DeBaun
authors.forename: Sharada A
authors.initials: SA
authors.lastname: Sarnaik
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Rodeghier
authors.forename: Caterina P
authors.initials: CP
authors.lastname: Minniti
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Howard
authors.forename: Rathi V
authors.initials: RV
authors.lastname: Iyer
authors.forename: Baba
authors.initials: B
authors.lastname: Inusa
authors.forename: Paul T
authors.initials: PT
authors.lastname: Telfer
authors.forename: Melanie
authors.initials: M
authors.lastname: Kirby-Allen
authors.forename: Charles T
authors.initials: CT
authors.lastname: Quinn
authors.forename: Françoise
authors.initials: F
authors.lastname: Bernaudin
authors.forename: Gladstone
authors.initials: G
authors.lastname: Airewele
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Woods
authors.forename: Julie Ann
authors.initials: JA
authors.lastname: Panepinto
authors.forename: Beng
authors.initials: B
authors.lastname: Fuh
authors.forename: Janet K
authors.initials: JK
authors.lastname: Kwiatkowski
authors.forename: Allison A
authors.initials: AA
authors.lastname: King
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Rhodes
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Thompson
authors.forename: Mark E
authors.initials: ME
authors.lastname: Heiny
authors.forename: Rupa C
authors.initials: RC
authors.lastname: Redding-Lallinger
authors.forename: Fenella J
authors.initials: FJ
authors.lastname: Kirkham
authors.forename: Hernan
authors.initials: H
authors.lastname: Sabio
authors.forename: Corina E
authors.initials: CE
authors.lastname: Gonzalez
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Saccente
authors.forename: Karen A
authors.initials: KA
authors.lastname: Kalinyak
authors.forename: John J
authors.initials: JJ
authors.lastname: Strouse
authors.forename: Jason M
authors.initials: JM
authors.lastname: Fixler
authors.forename: Mae O
authors.initials: MO
authors.lastname: Gordon
authors.forename: J Phillip
authors.initials: JP
authors.lastname: Miller
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Noetzel
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Ichord
authors.forename: James F
authors.initials: JF
authors.lastname: Casella
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000097:blood / Q000453:epidemiology* / Q000628:therapy*; D058070:Asymptomatic Diseases / Q000453:epidemiology; D001794:Blood Pressure; D001803:Blood Transfusion; D002544:Cerebral Infarction / Q000097:blood / Q000453:epidemiology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006451:Hemoglobin, Sickle / Q000378:metabolism; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D017678:Sex Distribution; D017086:beta-Thalassemia / Q000097:blood / Q000453:epidemiology*
chemical_list: D006451:Hemoglobin, Sickle
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