Background: Sickle cell disease (SCD) is an autosomal recessive disease resulting in a broad range of functional and structural renal and cardiac alterations. Chronic kidney disease is with associated proteinuria, microalbuminuria and hemoglobinuria. Cardiac complications include diastolic heart disease, dysrhythmia and sudden death. In patients with advancing age, cardio-renal dysfunction can have substantial effects on morbidity and premature mortality. Our study aims to compare 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-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 had SCN. Primary endpoints were incidence of MACE and all-cause mortality. Patients with MACE encompassed those with nonfatal stroke, nonfatal myocardial infarction and heart failure exacerbations. 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 p <0.05. All outcomes were adjusted for various demographic variables and comorbidities.
Results: SCN patients had a 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 significant 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).
Conclusions: SCN was associated with significantly higher odds of all-cause mortality but was not associated with significantly higher odds of MACE or prolonged LOS. While SCN may be associated with all-cause mortality, further studies are warranted to understand the association of SCN and cardiovascular complications.