Pulmonary Embolism in Sickle Cell Disease: A Case-Control Study
Published Date:May 2012
Source:J Thromb Haemost. 10(5):760-766.
Anemia, Sickle Cell
Predictive Value Of Tests
Severity Of Illness Index
Sickle Cell Disease
Tomography, X-Ray Computed
Pubmed Central ID:PMC3343190
Funding:1-H-30-MC-0038-01/PHS HHS/United States
U10DD000193/DD/NCBDD CDC HHS/United States
UL-1 RR024153/RR/NCRR NIH HHS/United States
UL1 RR024153/RR/NCRR NIH HHS/United States
UL1 RR024153-01/RR/NCRR NIH HHS/United States
UL1 TR000005/TR/NCATS NIH HHS/United States
Pulmonary embolism (PE) is a leading cause of mortality in hospitalized patients, yet the prevalence of PE in sickle cell disease (SCD) and its relation to disease severity or intrinsic hypercoagulability are not established.
We estimated inpatient PE incidence and prevalence among SCD and non-SCD populations in Pennsylvania, and compared severity of illness and mortality, using Pennsylvania Health Care Cost Containment Council (PHC4) discharge data, 2001-2006. Risk factors for PE were assessed in a case-control study of discharges from the University of Pittsburgh Medical Archival Records System (MARS).
The incidence of inpatient PE was higher in the SCD PA population than in the non-SCD Pennsylvania population, 2001-2006. The PE prevalence among SCD discharges ≤50 years of age, 0.57%, was similar to that in non-SCD Pennsylvania discharges, 0.60%, and unchanged after adjustment for race. Among SCD discharges, those developing PE were significantly older, with longer length ofstay, greater severity of illness, and higher mortality, p<0.001, than SCD without PE. Among PE discharges, SCD had similar severity of illness, p=0.77, and mortality, p=0.39, but underwent fewer computerized tomographic scans, p=0.006, than non-SCD with PE. In the local case-control study, no clinical or laboratory feature was associated with PE.
The incidence of PE is higher and chest CT utilization is lower in SCD than non-SCD inpatients, suggesting that PE may be under-diagnosed.
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