Clinical predictors of poor outcomes in patients with sickle cell disease and COVID-19 infection.
Clinical predictors of poor outcomes in patients with sickle cell disease and COVID-19 infection.
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DOI：
10.1182/bloodadvances.2020003456
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发表时间：
2021-01-12
期刊：
影响因子：
7.5
通讯作者：
Klings ES
中科院分区：
文献类型：
--
作者：
Minniti CP;Zaidi AU;Nouraie M;Manwani D;Crouch GD;Crouch AS;Callaghan MU;Carpenter S;Jacobs C;Han J;Simon J;Glassberg J;Gordeuk VR;Klings ES
患有COVID-19的SCD患者表现出广泛的严重程度，病死率高于非SCD人群（10.9% vs 3.3%）。未接受羟基脲治疗的伴有终末器官损伤的老年患者出现急性肾损伤，LDH和D-二聚体水平升高，死亡风险较高。我们的目的是确定生活在4个主要大都市地区的镰状细胞病（SCD）和COVID-19患者的结局和生存的预测因素，以提供预防和护理的最佳方法。在四个COVID-19震中诊断为COVID-19的SCD患者的基线和临床过程中收集数据。患者出院后随访3个月。在66名患有COVID-19的SCD患者中，50名患者（75%）需要住院治疗，7名患者死亡（10.6%）。既存肾脏疾病（慢性肾脏疾病）患者更有可能住院。最常见的临床症状是血管闭塞性疼痛。50例住院患者中有30例（60%）发生急性胸部综合征，所有患者均死亡。死亡患者中年龄较大、有肺动脉高压、充血性心力衰竭、慢性肾脏疾病和中风病史的患者更常见，肌酐、乳酸脱氢酶和D-二聚体水平也更高。住院期间使用抗凝剂在死亡患者中的比例要低两倍。所有死亡均发生在未接受羟基脲或任何其他SCD修饰治疗的个体中。SCD和COVID-19患者表现出广泛的疾病严重程度。尽管SCD患者的中位年龄为34岁，但我们的病死率为10%，而普通人群的病死率为13%，但我们不能确切地说SCD患者的总死亡率更高。年龄>50岁的SCD患者，既存心肺疾病、肾脏疾病和/或中风，未接受过羟基脲治疗，血清肌酐、乳酸脱氢酶和D-二聚体水平较高，死亡风险较高，与基因型或性别无关。
SCD patients with COVID-19 display a broad range of severity, with a higher case fatality than the non-SCD population (10.9% vs 3.3%). Older patients not treated with hydroxyurea with end organ damage who present with acute kidney injury, and elevated LDH and D-dimer level are at higher risk of death. We aimed to identify predictors of outcomes and survival in patients living in 4 major metropolitan areas who had sickle cell disease (SCD) and COVID-19 to inform best approaches to prevention and care. Data were collected at baseline and during the clinical course in SCD patients diagnosed with COVID-19 in four COVID-19 epicenters. Patients were followed up posthospital discharge for up to 3 months. Of sixty-six SCD patients with COVID-19, fifty patients (75%) required hospitalization, and seven died (10.6%). Patients with preexisting kidney disease (chronic kidney disease) were more likely to be hospitalized. The most common presenting symptom was vaso-occlusive pain. Acute chest syndrome occurred in 30 (60%) of the 50 hospitalized patients and in all who died. Older age and histories of pulmonary hypertension, congestive heart failure, chronic kidney disease, and stroke were more prevalent in patients who died, as were higher creatinine, lactate dehydrogenase, and D-dimer levels. Anticoagulation use while inpatient was twice less common in patients who died. All deaths occurred in individuals not taking hydroxyurea or any other SCD-modifying therapy. Patients with SCD and COVID-19 exhibited a broad range of disease severity. We cannot definitively state that the overall mortality is higher in patients with SCD, although our case fatality rate was ∼10% compared with ∼3% in the general population, despite a median age of 34 years. Individuals with SCD aged >50 years, with preexisting cardiopulmonary, renal disease, and/or stroke not receiving hydroxyurea, who present with high serum creatinine, lactate dehydrogenase, and D-dimer levels, are at higher risk of death, irrespective of genotype or sex.
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影响因子：
--
作者：
Weiss SR;Leibowitz JL
通讯作者：
Leibowitz JL
影响因子：
3.7
作者：
Serjeant GR;Chin N;Asnani MR;Serjeant BE;Mason KP;Hambleton IR;Knight-Madden JM
通讯作者：
Knight-Madden JM
影响因子：
3.3
作者：
Lanzkron, Sophie;Carroll, C. Patrick;Haywood, Carlton, Jr.
通讯作者：
Haywood, Carlton, Jr.
影响因子：
10.1
作者：
Chakravorty S;Padmore-Payne G;Ike F;Tshibangu V;Graham C;Rees D;Stuart-Smith S
通讯作者：
Stuart-Smith S
影响因子：
3.2
作者：
Kato GJ
通讯作者：
Kato GJ