High lactate dehydrogenase levels at admission for painful vaso-occlusive crisis is associated with severe outcome in adult SCD patients

• Published in: Clinical biochemistry 2012-12, Vol.45 (18), p.1578-1582
• Main Authors: Stankovic Stojanovic, Katia, Steichen, Olivier, Lefevre, Guillaume, Bachmeyer, Claude, Avellino, Virginie, Grateau, Gilles, Girot, Robert, Lionnet, François
• Format: Article
• Language: English
• Subjects: Acute chest syndrome; Adult; Anemia, Sickle Cell - blood; Anemia, Sickle Cell - complications; Anemia, Sickle Cell - enzymology; Anemias. Hemoglobinopathies; Biological and medical sciences; Cardiovascular Diseases - blood; Cardiovascular Diseases - complications; Diseases of red blood cells; Female; Fever; Hematologic and hematopoietic diseases; Hospitalization; Humans; Investigative techniques, diagnostic techniques (general aspects); L-Lactate Dehydrogenase - blood; Lactate dehydrogenase; Male; Medical sciences; Pain - complications; Procalcitonin; Prognosis; Sickle cell disease; Young Adult
• ISSN: 0009-9120; 1873-2933
• DOI: 10.1016/j.clinbiochem.2012.07.114

The aim of this study is to assess biological prognostic factors at the onset of vaso-occlusive crisis (VOC) in adults with sickle cell disease (SCD). A monocentric prospective study including all patients admitted for VOC in a reference center for SCD was utilized. We used multivariate logistic regression to find independent predictors of severe evolution, defined by death or a worsening clinical state indicating transfusion or transfer to the intensive care unit. Eighty eight patients were included, 63% were women, median age of 23years, and 90% of patients were homozygous SCD, 10% compound heterozygous. VOC became severe in 17 patients. Patients with severe VOC were more frequently males, who also had higher white blood cell (WBC) count, procalcitonin (PCT), and lactate dehydrogenase (LDH) levels. LDH level was the best predictor of the outcome; WBC and PCT had no significant added predictive values when coupled with LDH in multivariable models, even in patients with fever or acute chest syndrome. Severe evolution always occurred when LDH levels were over 4 times the upper limit of the normal range at admission and never occurred when LDH levels were within the normal range. Further studies should confirm the predictive value of LDH before its widespread use as a prognostic factor. If it is confirmed, the benefit of preemptive transfusion when LDH levels at admission are very high could be investigated. ► Vasoocclusive crisis is the main reason for hospitalization in sickle cell disease. ► Factors at admission were assessed to predict the outcome. ► High LDH levels at admission were associated with severe evolution of VOC.