• Jérôme Cecchini, François Lionnet, Michel Djibré, Antoine Parrot, Katia Stankovic Stojanovic, Robert Girot, and Muriel Fartoukh.
• 1Service de Réanimation médico-chirurgicale, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Université Pierre et Marie Curie, Paris, France. 2Service de Médecine interne, Centre de référence de la drépanocytose adulte, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, and Université Pierre et Marie Curie, Paris, France. 3Service d'Hématologie biologique, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Université Pierre et Marie Curie, Paris, France.
• Crit. Care Med.. 2014 Jul 1;42(7):1629-39.

ObjectiveSickle cell disease is associated with a decreased life expectancy, half of the deaths occurring in the ICU. We aimed to describe the characteristics of sickle cell disease patients admitted to ICU and to identify early predictors of a complicated outcome, defined as the need for vital support or death.DesignRetrospective observational cohort study of sickle cell disease patients over a 6-year period.SettingICU of a French teaching hospital and sickle cell disease referral center.PatientsHundred thirty-eight ICU admissions in 119 sickle cell disease patients.InterventionsNone.Measurements And Main ResultsICU admission was mainly indicated for sickle cell disease-related events, especially acute chest syndrome. Mechanical ventilation, vasoactive drugs, and renal replacement therapy were administered to 25 (18%), 10 (7%), and 10 (7%) episodes, respectively. The complicated outcome group (n = 28; 20%) was characterized by a more aggressive acute disease within the 48 hours preceding ICU admission, with a higher respiratory rate, a more frequent acute kidney injury, and a more sustained drop of hemoglobin (all p < 0.01). All nine deaths (7%) were sickle cell disease related. None of the sickle cell disease baseline characteristics predicted accurately a complicated outcome. In multivariate analysis, hemoglobin less than or equal to 7.8 g/dL (odds ratio, 3.6; 95% CI, 1.1-11.9), respiratory rate more than or equal to 32 cycles/min (odds ratio, 5.6; 95% CI, 1.8-17.2), and acute kidney injury on ICU admission (odds ratio, 11.5; 95% CI, 2.5-52.6) were independently associated with a complicated outcome.ConclusionsSickle cell disease patients are at high risk of complications when admitted to the ICU. A sustained drop of hemoglobin, acute respiratory distress, and kidney injury at admission are strong predictors of a complicated outcome.

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