COVID-19 Pandemic Had Little Impact on Sickle Cell Disease Outcomes

Researchers found that there was no change in inpatient mortality or length of stay (LOS) for those with sickle cell disease (SCD) admitted during the COVID-19 pandemic in 2020 vs patients with SCD admitted during pre-pandemic years (2016-2019). Although those with SCD admitted during 2020 had more comorbidities and more commonly had respiratory failure and pulmonary embolism than those admitted in years prior, the pandemic itself was not an additional risk factor for those with SCD.

Sickle cell disease is an autosomal recessive hemoglobinopathy that most commonly affects the Black population. It is characterized by repeated severe acute pain episodes, infections, fatigue, and more. During the COVID-19 pandemic, and particularly in 2020, reduced access to services and fear of exposure to the virus resulted in a major decrease in overall health care utilization.

In this study, researchers queried the Nationwide Inpatient Sample (NIS) to determine the baseline characteristics of adult patients with SCD using ICD-10 codes. They also examined the prevalence of hospitalizations, as well as compared inpatient outcomes for this patient population before and during the COVID-19 pandemic.

A total of 456,750 patients were hospitalized with SCD and were stratified into two cohort groups: those admitted between 2016 through 2019 (n = 377,285) and those admitted during 2020 (n = 79,465).

The researchers assessed the following primary outcomes: inpatient mortality, LOS, and total hospitalization charges. They also assessed certain secondary outcomes: respiratory failure, need for mechanical ventilation, cerebrovascular accident, myocardial infarction, acute kidney injury, pulmonary embolism (PE), and need for blood transfusions. Multivariate linear and logistic regression analysis was performed to adjust for confounding variables.

According to the NIS data, age distribution and sex were similar between the two groups. There were no significant differences between the two groups regarding race, insurance type, hospital type, hospital size, hospital locations, and household income.

Patients admitted in 2020, however, were older and had more comorbidities compared with those admitted during prior years. In 2020, patients admitted with SCD had greater odds of developing acute respiratory failure and PE, though the overall prevalence was low (3.6% and 0.80%, respectively).

Surprisingly, there were no significant differences in inpatient mortality for patients with SCD admitted during 2020 when compared with prior years (0.31% vs 0.23%, respectively), nor in LOS (5.1 vs 4.9 days, respectively).

“Although disparities existed during the pandemic, it is fortunate that SCD itself did not serve as an additional risk factor for inpatient mortality and hospitalization duration,” the researchers concluded.

Reference
Vakil J, Deenadayalan V, Shaka H, Zia M. Assessing the impact of the covid-19 pandemic on outcomes of patient admitted with sickle cell disease. Talk presented at: ASH Annual Meeting; December 9-12, 2023; San Diego, CA. Accessed November 17, 2023. https://ash.confex.com/ash/2023/webprogram/Paper172786.html