Hemoglobin Target and Transfusion Modality for Adult Patients With Sickle Cell Disease Acute Chest Syndrome

被引:1
作者
Simonson, Joseph L. [1 ]
Rosentsveyg, Juliana A. [1 ]
Schwartz, Noah G. [2 ]
Agrawal, Abhinav [1 ]
Koenig, Seth [3 ]
Zaidi, Gulrukh Z. [1 ]
机构
[1] Donald & Barbara Zucker Sch Med Hofstra Northwell, Dept Med, Div Pulm Crit Care & Sleep Med, Hempstead, NY USA
[2] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA
[3] Montefiore Med Ctr, Dept Med, Div Pulm Med, Bronx, NY 10467 USA
关键词
sickle cell anemia; acute chest syndrome; blood transfusion; exchange transfusion;
D O I
10.1177/0885066620978770
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Despite the importance of transfusion in treating sickle cell disease acute chest syndrome, the target hemoglobin and optimal modality for transfusion remain unknown. Objectives: To compare hospital length of stay (LOS) in intensive care unit (ICU) patients with acute chest syndrome transfused to hemoglobin >= 8 g/dL versus patients transfused to hemoglobin < 8 g/dL; and to compare hospital LOS in acute chest syndrome patients treated with and without exchange transfusion. Methods: We performed a retrospective cohort study of all acute chest syndrome patients treated in the medical ICU at 2 tertiary care hospitals between January 2011 and August 2016 (n = 82). We compared median hospital LOS in patients transfused to hemoglobin >= 8 g/dL by the time of ICU transfer to the medical floor versus patients transfused to hemoglobin < 8 g/dL as well as patients who received exchange transfusion versus no exchange transfusion using Wilcoxon rank-sum tests. We modeled the association between hospital LOS and hemoglobin at ICU transfer to the medical floor using multivariable log-linear regression. Results: Median hospital LOS was about half as long for patients transfused to hemoglobin >= 8 g/dL versus hemoglobin < 8 g/dL (8.0 versus 16.5 days, P = 0.008). There was no difference in LOS for patients treated with and without exchange transfusion. On average, a 1 g/dL increase in hemoglobin was associated with a 19.5% decrease (95% CI 10.8-28.2%) in LOS, controlling for possible confounding factors. Conclusions: Transfusion to a hemoglobin target >= 8 g/dL is associated with decreased hospital LOS in patients with acute chest syndrome. There was no difference in LOS between patients who received exchange transfusion and those who did not.
引用
收藏
页码:100 / 106
页数:7
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