title: Risk factors for mortality in adult patients with sickle cell disease: a meta-analysis of studies in North America and Europe.
abstract: Although recent studies show an improved survival of children with sickle cell disease in the US and Europe, for adult patients mortality remains high. This study was conducted to evaluate the factors associated with mortality in adult patients following the approval of hydroxyurea. We first evaluated the association between selected variables and mortality at an academic center (University of North Carolina). Data sources were then searched for publications from 1998 to June 2016, with meta-analysis of eligible studies conducted in North America and Europe to evaluate the associations of selected variables with mortality in adult patients. Nine studies, combined with the UNC cohort (total n=3257 patients) met the eligibility criteria. Mortality was significantly associated with age (per 10-year increase in age) [7 studies, 2306 participants; hazard ratio (HR): 1.28; 95% confidence interval (CI): 1.10-1.50], tricuspid regurgitant jet velocity 2.5 m/s or more (5 studies, 1577 participants; HR: 3.03; 95%CI: 2.0-4.60), reticulocyte count (3 studies, 1050 participants; HR: 1.05; 95%CI: 1.01-1.10), log(N-terminal-pro-brain natriuretic peptide) (3 studies, 800 participants; HR: 1.68; 95%CI: 1.48-1.90), and fetal hemoglobin (7 studies, 2477 participants; HR: 0.97; 95%CI: 0.94-1.0). This study identifies variables associated with mortality in adult patients with sickle cell disease in the hydroxyurea era.
authors.affiliation: Department of Biostatistics, University of North Carolina, Chapel Hill.
authors.forename: Poulami
authors.initials: P
authors.lastname: Maitra
authors.affiliation: Division of Cardiology, University of North Carolina, Chapel Hill.
authors.forename: Melissa
authors.initials: M
authors.lastname: Caughey
authors.affiliation: Children's Hospital of Philadelphia.
authors.forename: Laura
authors.initials: L
authors.lastname: Robinson
authors.affiliation: Division of Hematology, The Ohio State University, Columbus.
authors.forename: Payal C
authors.initials: PC
authors.lastname: Desai
authors.affiliation: Division of Hematology/Oncology, University of North Carolina, Chapel Hill.
authors.forename: Susan
authors.initials: S
authors.lastname: Jones
authors.affiliation: Department of Medicine, Howard University, Washington, DC, USA.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Nouraie
authors.affiliation: Department of Medicine, University of Pittsburgh, PA, USA.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Gladwin
authors.affiliation: Children's Hospital of Philadelphia.
authors.forename: Alan
authors.initials: A
authors.lastname: Hinderliter
authors.affiliation: Department of Biostatistics, University of North Carolina, Chapel Hill.
authors.forename: Jianwen
authors.initials: J
authors.lastname: Cai
authors.affiliation: Division of Hematology/Oncology, University of North Carolina, Chapel Hill kataga@med.unc.edu.
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Ataga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000755:Anemia, Sickle Cell / Q000150:complications / Q000453:epidemiology / Q000235:genetics / Q000401:mortality*; D005060:Europe; D005260:Female; D005838:Genotype; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009656:North America; D016016:Proportional Hazards Models; D012307:Risk Factors; D055815:Young Adult; D055544:beta-Globins / Q000235:genetics
chemical_list: D055544:beta-Globins