title: Outcomes of adult patients with sickle cell disease admitted to the ICU: a case series*.
abstract: OBJECTIVE
  Sickle cell disease is associated with a decreased life expectancy, half of the deaths occurring in the ICU. We aimed to describe the characteristics of sickle cell disease patients admitted to ICU and to identify early predictors of a complicated outcome, defined as the need for vital support or death.
  
  
  METHODS
  Retrospective observational cohort study of sickle cell disease patients over a 6-year period.
  
  
  METHODS
  ICU of a French teaching hospital and sickle cell disease referral center.
  
  
  METHODS
  Hundred thirty-eight ICU admissions in 119 sickle cell disease patients.
  
  
  METHODS
  None.
  
  
  RESULTS
  ICU admission was mainly indicated for sickle cell disease-related events, especially acute chest syndrome. Mechanical ventilation, vasoactive drugs, and renal replacement therapy were administered to 25 (18%), 10 (7%), and 10 (7%) episodes, respectively. The complicated outcome group (n = 28; 20%) was characterized by a more aggressive acute disease within the 48 hours preceding ICU admission, with a higher respiratory rate, a more frequent acute kidney injury, and a more sustained drop of hemoglobin (all p < 0.01). All nine deaths (7%) were sickle cell disease related. None of the sickle cell disease baseline characteristics predicted accurately a complicated outcome. In multivariate analysis, hemoglobin less than or equal to 7.8 g/dL (odds ratio, 3.6; 95% CI, 1.1-11.9), respiratory rate more than or equal to 32 cycles/min (odds ratio, 5.6; 95% CI, 1.8-17.2), and acute kidney injury on ICU admission (odds ratio, 11.5; 95% CI, 2.5-52.6) were independently associated with a complicated outcome.
  
  
  CONCLUSIONS
  Sickle cell disease patients are at high risk of complications when admitted to the ICU. A sustained drop of hemoglobin, acute respiratory distress, and kidney injury at admission are strong predictors of a complicated outcome.
authors.affiliation: 1Service de Réanimation médico-chirurgicale, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Université Pierre et Marie Curie, Paris, France. 2Service de Médecine interne, Centre de référence de la drépanocytose adulte, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, and Université Pierre et Marie Curie, Paris, France. 3Service d'Hématologie biologique, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Université Pierre et Marie Curie, Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cecchini
authors.forename: François
authors.initials: F
authors.lastname: Lionnet
authors.forename: Michel
authors.initials: M
authors.lastname: Djibré
authors.forename: Antoine
authors.initials: A
authors.lastname: Parrot
authors.forename: Katia Stankovic
authors.initials: KS
authors.lastname: Stojanovic
authors.forename: Robert
authors.initials: R
authors.lastname: Girot
authors.forename: Muriel
authors.initials: M
authors.lastname: Fartoukh
mesh_terms: D056586:Acute Chest Syndrome / Q000209:etiology; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000401:mortality; D002317:Cardiovascular Agents / Q000008:administration & dosage; D005260:Female; D005602:France; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000706:statistics & numerical data*; D008297:Male; D017582:Renal Replacement Therapy / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D002317:Cardiovascular Agents