Patients with sickle cell disease (SCD) who have a history of disease-related comorbidities were found to be at greater risk for worse COVID-19 outcomes, researchers reported.
Hospitalization for COVID-19 was more likely to occur in children if they had frequent prior acute care visits for pain (relative risk [RR] 2.15, P<0.0001), as well as SCD-related heart and lung comorbidities (RR 1.61, P=0.0001). History of pain was also found to be a risk factor for hospitalization in adults (RR 1.78, P=0.002), noted Lana Mucalo, MD, of Medical College of Wisconsin in Milwaukee, and colleagues in Blood Advances.
“More than half of these patients showed with pain,” Mucalo told MedPage Today. “It was the most common complication.”
While it is unknown whether SCD acute pain would occur in these patients in the absence of COVID-19, “potential mechanisms support the concept that viral infection could precipitate acute SCD pain episodes,” Mucalo and team wrote.
“SCD is a chronic inflammatory disease,” Mucalo noted, pointing out that infection can exacerbate inflammation. An infection like COVID-19 that targets the lungs can lead to decreased oxygenation and blood hypoxia, “which promotes sickling, vaso-occlusive episodes and pain,” the team pointed out.
At the onset of the COVID pandemic, Mucalo and colleagues recognized the need to acquire knowledge about this infection and established the international SECURE-SCD Registry to collect data on patients with SCD and COVID-19. They used data from SECURE-SCD to identify factors associated with hospitalization and serious illness in patients with SCD.
Their analysis included 750 children and adults with SCD and COVID-19 who were reported in the registry from March 20, 2020 to March 23, 2021. Slightly more than half (51.5%) were over the age of 18 (median age 31 years), while the remaining 48.5% were pediatric patients (median age 11 years).
Patient data came from institutions in Belgium, Brazil, Canada, France, French Guiana, Greece, Guadeloupe, Lebanon, Nigeria, Oman, Sweden, Switzerland, and the U.S.
Prior acute care visits for pain were the most common SCD-related comorbidity among both children (55.5%) and adults (78.5%). Acute chest syndrome within the past 3 years was reported in 29.4% of children and 29.5% of adults.
In other study findings, children with a history of pain (RR 3.09, P=0.009), SCD-related heart and lung comorbidities (RR 1.76, P=0.03), and SCD-related renal comorbidities (RR 3.67, P<0.0001) were at a higher risk of developing serious COVID illness.
Additionally, history of pain was a risk factor for serious COVID illness in adults (RR 1.94, P=0.02).
A history of pain and SCD-related renal comorbidities increased the risk for pain during COVID in children, while a history of pain, SCD-related heart and lung comorbidities, and female sex increased risk of pain during COVID in adults, the researchers said.
The researchers also determined that while hydroxyurea lowers the risk of presenting with pain in adults who have COVID, taking the drug as a disease-modifying therapy did not result in any difference in COVID illness severity or need for hospitalization in SCD patients
“What was interesting was that for some patients who have never experienced pain, the first time they ever had pain was when they got COVID-19,” Mucalo said. “This sends the message that when SCD patients go to the emergency department with pain they should definitely be tested for COVID-19 because that may be their only symptom.”
Additionally, it is important for both patients and physicians to realize that some complications and comorbidities associated with SCD can be potentially life-threatening when dealing with a COVID-19 infection, she added. “These patients who are at an increased risk should definitely consider vaccination.”
Last Updated July 01, 2021
This research was supported by the Doris Duke Charitable Foundation and the National Center for Advancing Translational Sciences.
The authors reported no disclosures.