title: Lactate Dehydrogenase: A Marker of the Severity of Vaso-Occlusive Crisis in Children with Sickle Cell Disease Presenting at the Emergency Department.
abstract: The aim of this study was to describe the characteristics of vaso-occlusive crises (VOC) in children with sickle cell disease and to identify factors associated with greater severity. We performed a prospective observational study from August 2012 to January 2014. The study population comprised patients with sickle cell disease who consulted at the emergency department (ED) for VOC. We recorded demographic variables, history of complications related to the disease, and data on usual treatment. We also assessed pain, analgesia at home, need for admission, length of stay, and analgesia during admission. Analytical parameters were collected. A total of 29 patients with VOC were included. The patient's usual treatment was hydroxyurea (HU) in 69.0%, and 7.0% required chronic transfusions. In the ED, 90.0% had moderate or severe pain, even though 86.0% had received analgesia at home (41.4% minor opioids). Overall, 27 of the 29 patients were admitted, and 56.0% needed major opioids. Higher lactate dehydrogenase (LDH) levels were related to the use of major opioids during admission (p = 0.038). A significant difference was recorded between the median number of days of admission for patients receiving non-steroidal anti-inflammatory drugs and for those requiring intravenous opioids (p = 0.005). Most patients with VOC were admitted to hospital. Lactate dehydrogenase level in the ED was a predictor of severity and was associated with the need for major opioids during admission and more days of admission.
authors.affiliation: a Pediatric Hematology Unit , Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: García-Morin
authors.affiliation: b Neonatology Department , Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: López-Sangüos
authors.affiliation: c Emergency Department , Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Vázquez
authors.affiliation: d Cardiology Department , Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Alvárez
authors.affiliation: c Emergency Department , Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Marañón
authors.affiliation: a Pediatric Hematology Unit , Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Huerta
authors.affiliation: a Pediatric Hematology Unit , Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Cela
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000755:Anemia, Sickle Cell / Q000150:complications*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008297:Male; D010146:Pain / Q000188:drug therapy; D059408:Pain Management / Q000379:methods; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D000701:Analgesics, Opioid; D007770:L-Lactate Dehydrogenase; D006918:Hydroxyurea
keywords: Emergency department (ED); lactate dehydrogenase (LDH); major opioid; sickle cell disease; vaso-occlusive crises (VOC)