Risk Factors for Acute Chest Syndrome in Patients From Low Socioeconomic Background

Araújo, Jerônimo Gonçalves de; Araújo-Melo, Carlos André; Menezes-Neto, Osvaldo Alves de; Silveira, Diego Fernandes Chagas da; Correia, Juliana Mendes; Cipolotti, Rosana

doi:10.1097/mph.0b013e31821ed2f0

Cited by 5 publications

(3 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another risk factor that has been shown to predict recurrence of ACS episodes is a history of ACS in younger age, especially in the first 3 years of life, as reported by two independent cohorts of pediatric patients. 49 , 50 Moreover, the highest incidence rate of recurrence has been reported to be within 6 months from the last event. 51 Perhaps pulmonary injury from previous ACS episodes predisposes to increased susceptibility to recurrent events or alternatively a genetic predisposition underlies the development of frequent ACS episodes.…”

Section: Risk Factorsmentioning

confidence: 99%

Acute Chest Syndrome in Children with Sickle Cell Disease

Jain

Bakshi

Krishnamurti

2017

Pediatric Allergy, Immunology, and Pulmonology

116

View full text Add to dashboard Cite

Acute chest syndrome (ACS) is a frequent cause of acute lung disease in children with sickle cell disease (SCD). Patients may present with ACS or may develop this complication during the course of a hospitalization for acute vaso-occlusive crises (VOC). ACS is associated with prolonged hospitalization, increased risk of respiratory failure, and the potential for developing chronic lung disease. ACS in SCD is defined as the presence of fever and/or new respiratory symptoms accompanied by the presence of a new pulmonary infiltrate on chest X-ray. The spectrum of clinical manifestations can range from mild respiratory illness to acute respiratory distress syndrome. The presence of severe hypoxemia is a useful predictor of severity and outcome. The etiology of ACS is often multifactorial. One of the proposed mechanisms involves increased adhesion of sickle red cells to pulmonary microvasculature in the presence of hypoxia. Other commonly associated etiologies include infection, pulmonary fat embolism, and infarction. Infection is a common cause in children, whereas adults usually present with pain crises. Several risk factors have been identified in children to be associated with increased incidence of ACS. These include younger age, severe SCD genotypes (SS or Sβ0 thalassemia), lower fetal hemoglobin concentrations, higher steady-state hemoglobin levels, higher steady-state white blood cell counts, history of asthma, and tobacco smoke exposure. Opiate overdose and resulting hypoventilation can also trigger ACS. Prompt diagnosis and management with intravenous fluids, analgesics, aggressive incentive spirometry, supplemental oxygen or respiratory support, antibiotics, and transfusion therapy, are key to the prevention of clinical deterioration. Bronchodilators should be considered if there is history of asthma or in the presence of acute bronchospasm. Treatment with hydroxyurea should be considered for prevention of recurrent episodes. This review evaluates the etiology, pathophysiology, risk factors, clinical presentation of ACS, and preventive and treatment strategies for effective management of ACS.

show abstract

Section: Risk Factorsmentioning

confidence: 99%

Acute Chest Syndrome in Children with Sickle Cell Disease

Jain

Bakshi

Krishnamurti

2017

Pediatric Allergy, Immunology, and Pulmonology

116

View full text Add to dashboard Cite

show abstract

“…In contrast, the only risk factor that predicted ACS in a Brazilian study reported by Araújo et al . was a history of previous admission. Historically, half of all SCD patients had at least one episode of ACS in their lifetime and a subset had multiple events.…”

mentioning

confidence: 99%

Clinical correlates of acute pulmonary events in children and adolescents with sickle cell disease

Paul

Minniti

Nouraie

et al. 2013

European J of Haematology

View full text Add to dashboard Cite

Objectives We aimed to identify risk factors for acute pulmonary events in children and adolescents in the Pulmonary Hypertension and the Hypoxic Response in SCD (PUSH) study. Methods Patients with hemoglobin SS (n=376) and other sickle cell genotypes (n=127) aged 3-20 years were studied at four centers in a cross-sectional manner. A sub-group (n=293) was followed for a median of 21 months (range 9-35). Results A patient-reported history of one or more acute pulmonary events, either acute chest syndrome (ACS) or pneumonia, was obtained in 195 hemoglobin SS patients (52%) and 51 patients with other genotypes (40%). By logistic regression, history of acute pulmonary events was independently associated with patient-reported history of asthma (p<0.0001), older age (p=0.001), >3 severe pain episodes in the preceding 12 months (p=0.002), higher tricuspid regurgitation velocity (TRV) (p=0.028), and higher white blood cell (WBC) count (p=0.043) among hemoglobin SS patients. History of acute pulmonary events was associated with >3 severe pain episodes (p=0.009) among patients with other genotypes. During follow-up, 43 patients (15%) had at least one new ACS episode including 11 without a baseline history of acute pulmonary events. History of acute pulmonary events (odds ratio 5.4; p<0.0001) and younger age (odds ratio 0.9; p=0.010) were independently associated with developing a new episode during follow-up. Conclusions Asthma history, frequent pain and higher values for TRV and WBC count were independently associated with history of acute pulmonary events in hemoglobin SS patients and frequent pain was associated in those with other genotypes. Measures to reduce pain episodes and control asthma may help to decrease the incidence of acute pulmonary events in SCD.

show abstract

“…The number of previous admissions for SCD and prior ACS episodes was found to be higher in the corticosteroid-treated group, albeit they did not reach statistical significance. A history of previous hospital admission remains an independent risk factor for ACS [ 18 ]. This has also been proven in a large retrospective study by Quinn et al [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%