Liver Cirrhosis and In-Hospital Outcomes in Patients With Sickle Cell Crises

Sickle cell disease (SCD) is a hematologic disorder characterized by chronic hemolysis, vaso-occlusion, and end-organ dysfunction. Patients with SCD may experience acute episodes known as sickle cell crises, which are sudden, severe complications typically involving pain or organ-specific manifestations resulting from vaso-occlusion. Sickle cell hepatopathy includes acute and chronic liver complications, with cirrhosis contributing to inflammation and hepatic decompensation. The impact of cirrhosis on in-hospital outcomes remains unclear. This study examines the association between cirrhosis and in-hospital outcomes in adults hospitalized with Sickle cell disease using the 2021 National Inpatient Sample (NIS).

A retrospective cohort study using the 2021 NIS identified adults (≥ 18 years) hospitalized with sickle cell crises, stratified by cirrhosis status. Cirrhosis was identified through secondary diagnoses, and key variables included demographics, comorbidities, and hospital characteristics. Logistic regression models adjusted for confounders and for assessed outcomes. Survey weights ensured national representativeness (p < 0.05).

Hospitalized cirrhotic patients were older with more comorbidities. In-hospital mortality was higher in hospitalized cirrhotic patients (2.86% vs. 0.27%; adjusted OR 3.79, 95% CI 1.50-9.54; p = 0.005). Mechanical ventilation was more frequent (3.39% vs. 0.27%; adjusted OR 5.46, 95% CI 2.07-14.36; p = 0.001) and vasopressor use was higher but not statistically significant.

Cirrhosis worsens in-hospital outcomes for patients hospitalized with SCC. Enhanced clinical monitoring and tailored management are important. Future studies should explore interventions to mitigate hepatic complications in SCC.

The authors have confirmed clinical trial registration is not needed for this submission.