Outcomes related to intravenous fluid administration in sickle cell patients during vaso-occlusive crisis
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ORIGINAL ARTICLE
Outcomes related to intravenous fluid administration in sickle cell patients during vaso-occlusive crisis Daria Gaut 1
&
Jennifer Jones 1 & Caroline Chen 1 & Sanaz Ghafouri 1 & Mei Leng 2 & Roswell Quinn 1
Received: 25 September 2019 / Accepted: 20 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract While fluid replacement therapy is a primary treatment modality used in vaso-occlusive crises for sickle cell disease, data is limited on its safety, efficacy, and variability. We performed a retrospective analysis on 157 unique patient encounters from 49 sickle cell patients hospitalized with a vaso-occlusive episode at our institution from 2013 to 2017. The median length of hospital stay was 4 days (IQR 2–7). The mean total amount of intravenous fluid administered during the hospitalization was 7.4 L (Std 9.6). The mean total amount of fluid intake including intravenous fluids, blood transfusions, and oral fluids was 14.2 L (Std 18.2). Multivariate analyses revealed significant associations between the development of any adverse event (including a new oxygen requirement, acute chest syndrome, aspiration event, other hospital-acquired infection, acute kidney injury, and intensive care unit transfer) and the following variables: intravenous fluid administered in the first 24 h (p = 0.001, OR 1.899, 95% CI 1.319– 2.733), total amount of intravenous fluid administered (p = 0.005, OR 1.081, 95% CI 1.023–1.141), and total amount of fluid intake including oral fluids, blood transfusions, and intravenous fluids (p = 0.009, OR 1.046, 95% CI 1.011–1.081). Other factors found to be significantly associated with any adverse event were dialysis dependence prior to admission (p < 0.001, OR 12.984, 95% CI 3.660–46.056) and admission to an inpatient service versus an emergency room or observation unit (p = 0.008, OR 3.201, 95% CI 1.346–7.612). While fluid administration may theoretically slow the sickling process, this data suggests that fluid administration during a vaso-occlusive episode, and especially total volume given in the first 24 h, may also lead to adverse events. Keywords Sickle cell disease . Vaso-occlusive crisis . Fluid replacement . Hydration . Adverse event
Abbreviations ACS Acute chest syndrome ER (emergency room) IQR Interquartile range IV Intravenous SCD Sickle cell disease Std Standard deviation
TACO TRALI VOC
Daria Gaut and Jennifer Jones share first authorship.
Introduction
* Daria Gaut [email protected] 1
Deparment of Medicine, David Geffen School of Medicine, University of California Los Angeles, 200 UCLA Medical Plaza, Suite 420, Los Angeles, CA 90095, USA
2
Division of General Internal Medicine and Health Services Research, Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
Transfusion-associated circulatory overload Transfusion-related acute lung injury Vaso-occlusive crisis
Acute painful or vaso-occlusive crisis (VOC) is the most common reason for a sickle cell
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