Contemporary Trends,In-Hospital Outcomes,and Adverse Prognosticators of Sickle Cell Patients with Cardiovascular and Thromboembolic Complications: A National Database Analysis

Abstract

Sickle cell disease (SCD) leads to red blood cell deformities resulting in vaso-occlusion and multiorgan damage. Outcomes and adverse prognosticators among SCD patients with cardiovascular and thromboembolic (CVTE) complications are not well established. Therefore, we aimed to assess characteristics, outcomes, and mortality predictors for hospitalized SCD patients with CVTE complications. The National Inpatient Sample (2012-2021) was queried using ICD-9 and -10 codes for CVTE complications and relevant data in SCD patients. Mortality trends were examined with the Cochran-Armitage test, and factors associated with mortality were identified with multivariable logistic regression accounting for the weighted survey design. There were 1 388 310 SCD-related hospitalizations (mean age 31.3 ± 0.1 years; 56.4% female), of which 441 820 (31.8%) involved CVTE complications, including deep vein thrombosis (33.6%), pulmonary embolism (27%), acute chest syndrome (26%), congestive heart failure (21.3%), and pulmonary hypertension (18.2%). In-hospital mortality was higher in patients with CVTE complications (1.5% vs 0.3%, P < .0001). Charlson comorbidity index, myocardial infarction, arrhythmias, stroke, pulmonary embolism, and COVID-19 infection were identified as predictors of inpatient mortality. In conclusion, CVTE complications are associated with increased inpatient mortality. Early recognition of mortality predictors may support more effective risk stratification and timely interventions.