Predicting Acute Chest Syndrome Risk in Sickle Cell Anemia Children During Vaso-occlusive Crisis Hospitalizations

Abstract

Abstract Sickle cell anemia (SCA) is a globally prevalent inherited condition, with acute chest syndrome (ACS) being one of its most severe complications. ACS frequently leads to hospitalization, necessitates intensive care unit (ICU) admission, and can even result in death. This research aimed to discern early indicators of impending ACS in children with SCA who were initially hospitalized due to painful vaso-occlusive crises (VOC). A retrospective, case-control investigation was carried out at the King Saud Medical City in Riyadh, Saudi Arabia, encompassing 120 patients aged 1 to 14 years from January 2021 to December 2022. Patients were classified into two groups: those who developed ACS during hospital stay (cases) and those who did not develop ACS (controls). The study compared demographic factors, laboratory results, vital and clinical signs, and treatment protocols between these groups. Findings revealed that a previous diagnosis of asthma, a history of ACS, recent upper respiratory tract symptoms prior to admission, and the need for a blood transfusion within the first 24 hours of admission due to a drop in hemoglobin levels were all significant predictors of impending ACS. Further regression analysis indicated that elevated steady-state mean corpuscular volume (MCV), leukocyte count, total bilirubin, and an increased absolute neutrophil count (ANC) level 24 hours post-admission also foreshadowed impending ACS in patients admitted for VOC. Additionally, the location of pain was found to be significant with ACS incidence being higher in patients experiencing back pain, while patients with pain confined to the limbs had a lower incidence of ACS during admission. The average duration of hospital stay was notably longer for the ACS group, averaging 7.6 days compared to 5.8 days for VOC alone. 15.7% of patients initially admitted with VOC were diagnosed with ACS. Most ACS cases were managed with transfusions and antibiotics, and nearly one-third of patients required admission to an ICU or high dependency area.