title: Score Predicting Acute Chest Syndrome During Vaso-occlusive Crises in Adult Sickle-cell Disease Patients.
abstract: BACKGROUND
  Vaso-occlusive crisis (VOC), hallmark of sickle-cell disease (SCD), is the first cause of patients' Emergency-Room admissions and hospitalizations. Acute chest syndrome (ACS), a life-threatening complication, can occur during VOC, be fatal and prolong hospitalization. No predictive factor identifies VOC patients who will develop secondary ACS.
  
  
  METHODS
  This prospective, monocenter, observational study on SS/S-β0thalassemia SCD adults aimed to identify parameters predicting ACS at Emergency-Department arrival. The primary endpoint was ACS onset within 15days of admission. Secondary endpoints were hospitalization duration, morphine consumption, pain evaluation, blood transfusion(s) (BT(s)), requiring intensive care and mortality.
  
  
  RESULTS
  Among 250 VOCs included, 247 were analyzed. Forty-four (17.8%) ACSs occurred within 15 (median [IQR] 3 [2, 3]) days post-admission based on auscultation abnormalities; missing chest radiographs excluded three patients. Comparing ACS to VOC, respectively, median hospital stay was longer 9 [7-11] vs 4 [3-7] days (p<0.0001), 7/41 (17%) vs 1/203 (0.5%) required intensive care (p<0.0001), and 20/41 (48.7%) vs 6/203 (3%) required BTs (p<0.0001). No patient died. The multivariate model retained reticulocyte and leukocyte counts, and spine and/or pelvis pain as being independently associated with ACS; the resulting ACS-predictive score's area under the ROC was 0.840 [95% CI 0.780-0.900], 98.8% negative-predictive value and 39.5% positive-predictive value for the real ACS incidence.
  
  
  CONCLUSIONS
  The ACS-predictive score is simple, easily applied and could change VOC management and therapeutic perspectives. Assessed ACS risk could lead to earlier discharges or close monitoring and rapid medical intensification to prevent ACS.
authors.affiliation: IMRB, Henri-Mondor Hospital-UPEC, Créteil, France; Department of Internal Medicine, Henri-Mondor Hospital-UPEC, Créteil, France. Electronic address: pablo.bartolucci@aphp.fr.
authors.forename: Pablo
authors.initials: P
authors.lastname: Bartolucci
authors.affiliation: IMRB, Henri-Mondor Hospital-UPEC, Créteil, France; Department of Internal Medicine, Henri-Mondor Hospital-UPEC, Créteil, France.
authors.forename: Anoosha
authors.initials: A
authors.lastname: Habibi
authors.affiliation: Department of Internal Medicine, Henri-Mondor Hospital-UPEC, Créteil, France.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Khellaf
authors.affiliation: Clinical Research Unit, Department of Public Health, Henri-Mondor Hospital-UPEC, Créteil, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Roudot-Thoraval
authors.affiliation: Department of Immunology, Henri-Mondor Hospital-UPEC, Créteil, France.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Melica
authors.affiliation: Department of Immunology, Henri-Mondor Hospital-UPEC, Créteil, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Lascaux
authors.affiliation: Department of Biochemistry, Henri-Mondor Hospital-UPEC, Créteil, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Moutereau
authors.affiliation: Department of Biochemistry, Henri-Mondor Hospital-UPEC, Créteil, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Loric
authors.affiliation: Department of Hematology and Immunology, Henri-Mondor Hospital-UPEC, Créteil, France.
authors.forename: Orianne
authors.initials: O
authors.lastname: Wagner-Ballon
authors.affiliation: Sickle Cell Referral Center, Henri-Mondor Hospital-UPEC, Créteil, France.
authors.forename: Jugurtha
authors.initials: J
authors.lastname: Berkenou
authors.affiliation: Emergency Department, Henri-Mondor Hospital-UPEC, Créteil, France.
authors.forename: Aline
authors.initials: A
authors.lastname: Santin
authors.affiliation: Department of Internal Medicine, Henri-Mondor Hospital-UPEC, Créteil, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Michel
authors.affiliation: Emergency Department, Henri-Mondor Hospital-UPEC, Créteil, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Renaud
authors.affiliation: IMRB, Henri-Mondor Hospital-UPEC, Créteil, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Lévy
authors.affiliation: IMRB, Henri-Mondor Hospital-UPEC, Créteil, France; Department of Internal Medicine, Henri-Mondor Hospital-UPEC, Créteil, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Galactéros
authors.affiliation: Department of Internal Medicine, Henri-Mondor Hospital-UPEC, Créteil, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Godeau
mesh_terms: D056586:Acute Chest Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D000755:Anemia, Sickle Cell / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D002637:Chest Pain; D015897:Comorbidity; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D011379:Prognosis; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Acute chest syndrome; Prospective study; Score; Sickle cell disease; Vaso-occlusive crisis