背景:镰状细胞病(SCD)是一种常染色体隐性遗传疾病,可导致溶血性贫血和复发性血管闭塞事件。因此,它可以导致广泛的功能和结构性肾脏和心脏改变。慢性肾脏病(CKD),在SCD中,与蛋白尿有关,微量白蛋白尿,和血红蛋白尿症.SCD的心脏并发症包括肺动脉高压,左心室舒张性心脏病,心律失常,突然死亡。在年龄增长的患者中,心肾功能不全可对发病率和死亡率产生重大影响.我们的主要目的是比较镰状细胞肾病(SCN)中主要不良心脏事件(MACE)和全因死亡率的发生率。方法本回顾性研究,我们使用国际疾病分类(ICD)-10编码来确定2019年诊断为MACE且先前诊断为SCD和/或SCN的入院.我们对超过18岁的成年患者的HCA医疗保健企业数据仓库的搜索产生了6,693名SCD患者,其中658例(9.8%)有SCN。主要终点是MACE发生率和全因死亡率。MACE患者包括非致命性卒中患者,非致死性心肌梗死,充血性心力衰竭(CHF)加重。次要终点是住院时间(LOS)。对MACE和全因死亡率进行Logistic回归分析。LOS采用多元线性回归分析。对于显示p<0.05的分析,结果被认为具有统计学意义。所有结果均根据人口统计学变量和合并症进行调整。结果Logistic回归,合并症调整后,证明与无SCN的患者相比,SCN患者的全因死亡率(比值比[OR]2.343,p=0.035,95%置信区间[CI]1.063-5.166)显著较高.与没有SCN的相比,SCN患者发生MACE的几率不高(OR1.281,p=0.265,95%CI0.828-1.982).LOS的线性回归未显示与SCN的显着关联(p=0.169,95%CI0.157-0.899)。结论根据对6693例SCD患者的临床分析,SCN与全因死亡率的几率显著增高相关。SCN与显著较高的MACE或延长LOS的几率无关。
Background Sickle cell disease (SCD) is an autosomal recessive disease resulting in hemolytic anemia and recurrent vaso-occlusive events. Consequently, it can result in a broad range of functional and structural renal and cardiac alterations. Chronic kidney disease (CKD), in SCD, is associated with proteinuria, microalbuminuria, and hemoglobinuria. Cardiac complications in SCD include pulmonary hypertension, left ventricular diastolic heart disease, dysrhythmia, and sudden death. In patients with advancing age, cardio-renal dysfunction can have substantial effects on morbidity and mortality. Our primary aim was to compare the incidence of major adverse cardiac events (MACE) and all-cause mortality in sickle cell nephropathy (SCN). Methods In this retrospective study, we used International Classification of Diseases (ICD)-10 codes to identify admissions in 2019 with a diagnosis of MACE with a prior diagnosis of SCD and/or SCN. Our search of the HCA Healthcare Enterprise Data Warehouse for adult patients >18 years yielded 6,693 patients with SCD, of which 658 patients (9.8%) had SCN. Primary endpoints were incidence of MACE and all-cause mortality. Patients with MACE encompassed those with nonfatal stroke, nonfatal myocardial infarction, and congestive heart failure (CHF) exacerbations. A secondary endpoint was length of stay (LOS). Logistic regression analysis was used for MACE and all-cause mortality. LOS was analyzed using multiple linear regression analysis. Results were considered statistically significant for analyses showing p <0.05. All outcomes were adjusted for demographic variables and comorbidities. Results Logistic regression, after adjustment for comorbidities, demonstrated that SCN patients had significantly higher odds of all-cause mortality (odds ratio [OR] 2.343, p = 0.035, 95% confidence interval [CI] 1.063-5.166) compared to patients without SCN. Compared to those without SCN, those with SCN did not have a higher odds of MACE (OR 1.281, p = 0.265, 95% CI 0.828-1.982). Linear regression for LOS did not reveal a significant association with SCN (p = 0.169, 95% CI 0.157-0.899). Conclusion Based on the analysis of 6,693 patients with SCD, SCN was associated with significantly higher odds of all-cause mortality. SCN was not associated with significantly higher odds of MACE or prolonged LOS.