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Adults with sickle cell disease(SCD) are a growing population. Recent national estimates of outcomes in acute chest syndrome(ACS) among adults with SCD are lacking. We describe the incidence, outcomes and predictors of mortality in ACS in adults. We hypothesize that any need for mechanical ventilation is an independent predictor of mortality.MethodsWe performed a retrospective analysis of the Nationwide Inpatient Sample(2004–2010),the largest all payer inpatient database in United States, to estimate the incidence and outcomes of ACS needing mechanical ventilation(MV) and exchange transfusion(ET) in patients >21 years. The effects of MV and ET on outcomes including length of stay(LOS) and in-hospital mortality(IHM) were examined using multivariable linear and logistic regression models respectively. The effects of age, sex, race, type of sickle cell crisis, race, co-morbid burden, insurance status, type of admission, and hospital characteristics were adjusted in the regression models.ResultsOf the 24,699 hospitalizations, 4.6% needed MV(2.7% for <96 hours, 1.9% for ≥96 hours), 6% had ET, with a mean length of stay(LOS) of 7.8 days and an in-hospital mortality rate(IHM) of 1.6%. There was a gradual yearly increase in ACS hospitalizations that needed MV(2.6% in 2004 to 5.8% in 2010). Hb-SS disease was the phenotype in 84.3% of all hospitalizations. After adjusting for a multitude of patient and hospital related factors, patients who had MV for <96 hours(OR = 67.53,p<0.01) or those who had MV for ≥96 hours(OR = 8.73,p<0.01) were associated with a significantly higher odds for IHM when compared to their counterparts. Patients who had MV for ≥96 hours and those who had ET had a significantly longer LOS in-hospitals(p<0.001).ConclusionIn this large cohort of hospitalized adults with SCD patients with ACS, the need for mechanical ventilation predicted higher mortality rates and increased hospital resource utilization. Identification of risk factors may enable optimization of outcomes.

SCT indications and procedures are increasing worldwide. We sought to estimate the prevalence of acute respiratory failure (ARF) of any cause in hospitalized SCT patients, and assess the impact of invasive mechanical ventilation (IMV) on outcomes. We hypothesize that duration of IMV in such patients is an independent predictor of higher mortality. We performed a retrospective analysis of the largest all-payer hospitalization data set in the United States, Nationwide In-patient Sample for years [2004][2005][2006][2007][2008][2009][2010]. Of the 101 462 SCT hospitalizations, 6074 (6%) developed ARF and were the final cohort. Type of SCT with ARF included autologous 1987 (32.7%), allogeneic 3467 (57.1%) and cord blood 655 (10.8%). Duration of IMV included o96 h (17.1%) and ⩾ 96 h (41.1%). Overall in-hospital mortality (IHM) was 50.6% (3075). Predictors of IHM were IMV o96 h (odds ratio = 3.42 (2.44-4.79), P o0.0001) or IMV ⩾ 96 h (OR = 4.61 (3.17-6.70), P o 0.0001). Type of SCT, comorbid burden, gender, hospital-teaching status/bed size or insurance did not influence IHM. IMV ⩾ 96 h was associated with higher hospital charges (mean $762 515, 95% estimate 0.3991 (0.3123-0.4859), increase of $304 474, P o 0.0001) and higher length of stay (mean 61.5 days, 95% estimate 0.2198 (0.1531-0.2866), increase of 13 days, P o 0.0001). In conclusion, ARF in hospitalized SCT patients is not an uncommon occurrence and is associated with 50% mortality. Duration of IMV (⩾96 h) was an independent predictor of higher mortality rates. Hospital resource utilization was significant.

Objectives: Population-based analysis of incidence, comorbid conditions, microbiological characteristics, and outcomes of pyogenic liver abscess (PLA) in children. Methodology: Retrospective analysis of National Inpatient Sample (NIS) and Kids Inpatient database (KID) database from 2003 to 2014 and included patients between 1 and 20 years of age. Using ICD-9 codes, we identified all hospitalizations with PLA and compared them with 1 : 10 age- and gender-matched controls. Amebic liver abscess and Candida infections were excluded. Results: Total number of PLA admissions is 4075. The overall incidence of PLA is 13.5 per 100,000 hospitalizations, which increased by 60% between 2003 and 2014. The mean age of patients was 13.03 ± 6.1 years and were predominantly boys—61%. Of the comorbid conditions, hepatobiliary malignancy had the highest odds ratio (OR 71.8) followed by liver transplant (OR 38.4), biliary disease (OR 29.9), inflammatory bowel disease (IBD) (OR 5.35), other GI malignancies (OR 4.74), primary immune deficiency disorder (OR 4.13). Patients with PLA had 12 times increased odds of having associated severe sepsis. Infective endocarditis (IE) (OR 4.5), appendicitis (OR 1.8), and diverticulitis (OR 8.1) were significantly associated with PLA. Almost 39% (1575) of the PLA patients had positive culture, whereas Streptococcus (10.8%) and Staphylococcus spp (9.2%) were the most common pathogens. About 45% of PLA patients underwent percutaneous liver abscess aspiration whereas 4.1% had hepatic resection for PLA. The mortality rate of PLA was 0.8% (n = 32). Conclusions: The incidence of PLA is steadily increasing over the last decade among pediatric population in the United States. Hepatobiliary malignancy and liver transplant are the most common comorbid conditions associated with PLA.