Assessing the Impact of the Covid-19 Pandemic on Outcomes of Patient Admitted with Sickle Cell Disease

• Published in: Blood 2023-11, Vol.142 (Supplement 1), p.5124-5124
• Main Authors: Vakil, Jay, Deenadayalan, Vaishali, Shaka, Hafeez, Zia, Maryam
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2023-172786

Introduction: Sickle cell disease (SCD) is an autosomal recessive hemoglobinopathy which affects millions of people worldwide. It is caused by a substitution of the glutamic acid (Glu) amino acid with valine (Val) at the sixth position of the β-globin gene, resulting in a mutated hemoglobin tetramer, HbS, in the erythrocytes of affected individuals. This morphology results in sickle-shaped red blood cells and hemolysis when deoxygenated and leads to vaso-occlusion with associated ischemia. SCD is characterized by repeated severe acute pain episodes, acute chest syndrome, and can be complicated by stroke, nephropathy, avascular necrosis, and more. Many studies have shown disparities in outcomes in racial/ethnic minorities as well as in those with lower socioeconomic status. These factors have also been linked to increased risk of COVID-19 infection and infection related mortality. In this study, we aim to explore the baseline characteristics of patients with SCD, prevalence of hospitalizations, and compare inpatient outcomes during the COVID-19 pandemic with those prior to the pandemic. Methods: Nationwide Inpatient Sample (NIS) was queried to determine adult hospitalized patients with a primary diagnosis of SCD using ICD-10 codes. They were stratified into two cohort groups based on year of admission, comparing admissions during 2016-2019 with admission during the year 2020. Primary outcomes assessed were inpatient mortality, length of stay (LOS), and total hospitalization charges. Secondary outcomes included respiratory failure, need for mechanical ventilation, cerebrovascular accident (CVA), myocardial infarction (MI), acute kidney injury (AKI), pulmonary embolism (PE), and need for blood transfusions. Multivariate linear and logistic regression analysis was performed to adjust for confounding variables. Results: A total of 456, 750 patients were hospitalized with SCD. 377, 285 were admitted between 2016-2019 and 79, 465 were admitted during 2020. Age distribution and sex were similar between the two groups. Patients admitted in the year 2020 were older and had more comorbidities when compared to patients admitted during prior years. Distribution of race, insurance type, hospital type, hospital size, hospital locations, and household income was not significantly different between the two groups. In 2020 patients admitted with SCD had greater odds of developing acute respiratory failure and PE, though the overall prevalence of these secondary outcomes wer