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Clustering of end‐organ disease and earlier mortality in adults with sickle cell disease: A retrospective‐prospective cohort study
Author(s) -
Chaturvedi Shruti,
Ghafuri Djamila Labib,
Jordan Natalie,
Kassim Adetola,
Rodeghier Mark,
DeBaun Michael R.
Publication year - 2018
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.25202
Subject(s) - medicine , interquartile range , organ dysfunction , disease , retrospective cohort study , cohort , prospective cohort study , cause of death , cohort study , sepsis
Chronic end‐organ complications result in morbidity and mortality in adults with sickle cell disease (SCD). In a retrospective‐prospective cohort of 150 adults with SCD who received standard care screening for pulmonary function abnormalities, cardiac disease, and renal assessment from January 2003 to 2016, we tested the hypothesis that clustering of end‐organ disease is common and multiple organ impairment predicts mortality. Any end‐organ disease occurred in 59.3% of individuals, and 24.0% developed multiple organ (>1) end‐organ disease. The number of end‐organs affected was associated with mortality ( P ≤ .001); 8.2% (5 of 61) of individuals with no affected end‐organ, 9.4% (5 of 53) of those with 1 affected organ, 20.7% (6 of 29) of those with 2 affected end‐organs, and 85.7% (6 of 7) with 3 affected end‐organs died over a median follow up period of 8.7 (interquartile range 3.5‐11.4) years. Of the 22 individuals who died, 77.3% had evidence of any SCD‐related end‐organ impairment, and this was the primary or secondary cause of death in 45.0%. SCD‐related chronic impairment in multiple organs, and its association with mortality, highlights the need to understand the common mechanisms underlying chronic end‐organ damage in SCD, and the urgent need to develop interventions to prevent irreversible end‐organ complications in SCD.