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Hospitalization Events Among Adolescents and Adults With Sickle Cell Disease in a Tertiary Care Center in Central
Preetam Wasnik1, Pranita Das1, Ajit Kumar2
1General Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND.
Insights
Painful crises are the main reason for sickle cell disease hospitalizations, followed by infections. Patients with infections or vaso-occlusive crises experience longer hospital stays, highlighting the need for preventive care.
Area of Science:
- Hematology
- Internal Medicine
- Public Health
Background:
- Sickle cell disease (SCD) is an inherited blood disorder causing severe complications like vaso-occlusive crisis (VOC), acute chest syndrome (ACS), and organ damage.
- SCD necessitates frequent hospitalizations, imposing a significant burden on patients, caregivers, and healthcare systems.
- Hospital admission patterns for SCD vary globally.
Purpose of the Study:
- To identify the primary causes of hospitalization in adolescent and adult SCD patients.
- To investigate factors influencing the duration of hospital stays for SCD patients.
Main Methods:
- A prospective observational study was conducted at a tertiary care hospital.
- Adolescent and adult patients (15-45 years) diagnosed with SCD were enrolled.
- Data on hospitalization causes and length of stay were collected over one year.
Main Results:
- Painful crisis (VOC) was the leading cause of hospitalization, accounting for 63% of cases.
- Infections (17%), ACS (11%), and acute hemolytic crisis (9%) were other significant reasons for admission.
- Adults over 19 reported more joint, back, and chest pain; infections correlated with longer hospital stays.
Conclusions:
- Acute painful crises are the predominant reason for SCD hospitalizations, with infections and ACS also being common.
- Patients hospitalized for infections or VOC experienced prolonged hospital stays.
- Preventive strategies against infections and triggers for painful crises are crucial for managing SCD patients.
Background:
Sickle cell disease (SCD) is an inherited red blood cell disorder, wherein mutation causes the substitution of glutamic acid to valine at the sixth position of the β-globin chain. These include sickle cell anemia (homozygous sickle mutation), sickle-beta thalassemia, and hemoglobin SCD. The clinical manifestations of SCD are protean. Individuals with SCD suffer from both acute and chronic complications, which include recurring episodes of pain commonly called vaso-occlusive crisis (VOC) - acute chest syndrome (ACS); aseptic necrosis of the bone; micro-infarction of the spleen, brain, and kidney; infections; stroke; and organ damage affecting every part of the body. SCD necessitates frequent hospitalizations because of severe complications, which pose a significant burden on caregivers and economic strain on healthcare systems. The pattern of hospital admission with SCD varies in different parts of the world.
Objective:
This study aimed to determine the causes of hospitalization among adolescent and adult patients with SCD and to determine factors associated with their hospital stay.
Methods:
The study was a hospital-based prospective observational study comprising adolescent and adult patients diagnosed with SCD, aged 15-45 years, who were hospitalized in the Department of General Medicine at All India Institute of Medical Sciences in Raipur from August 2021 to August 2022.
Result:
According to our study, the primary reason for hospitalization was a painful crisis, accounting for 63% of cases, followed by infection (17%), ACS (11%), and acute hemolytic crisis (9%). Notably, we did not observe any significant differences between genders and causes of admission (p > 0.05). Joint pain (p = 0.005), back pain (p = 0.001), and chest pain (p = 0.001) were more frequently reported by adults over the age of 19. In addition, our analysis of the duration of hospital stays and various factors revealed that patients admitted for infections had a significantly longer mean hospital stay duration (p = 0.040).
Conclusion:
Acute painful crises were the primary cause of hospital admission among individuals with SCD; many patients also encountered infections and ACS. Furthermore, patients who experienced infections and VOC had a lengthier duration of hospital stay. Therefore, it is essential to provide them with comprehensive instructions on various preventive measures against infections and the factors that trigger painful crises.
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