Venous thromboembolism in adults with sickle cell disease: A national inpatient sample analysis (2016–2020) Free

Background

Patients with sickle cell disease (SCD) are at increased risk for venous thromboembolism (VTE). Despite this known association, the overall impact and clinical outcomes of VTE in individuals with SCD across the United States is not well charaterized. This study aims to examine the frequency and characteristics of VTE-related hospitalizations among U.S. adults with SCD, utilizing the National Inpatient Sample (NIS) database.

Methods

We performed a retrospective cross-sectional study using the NIS for 2016–2020. Adult hospitalizations with a primary diagnosis of VTE (deep-vein thrombosis or pulmonary embolism) were identified using ICD-10-CM codes and stratified by the presence of a secondary SCD diagnosis. Weighted estimates were used to calculate national hospitalization counts and rates. Patient demographics, racial distribution and comorbidities were compared between SCD and non-SCD VTE admissions. Multivariable logistic regression estimated adjusted odds ratios (aORs) for mortality and selected outcomes, and linear regression calculated adjusted mean differences (aMDs) for length of stay (LOS) and total cost of care (TOC).

Results

Out of approximately 1.42 million VTE hospitalizations between 2016–2020, 6,655 (0.5%) occurred in patients with SCD. SCD patients with VTE were significantly younger than VTE patients without SCD (mean age 41.4 vs. 63.1 years, p<0.001) and more often female (63.5% vs. 51.3%, p<0.001). The vast majority of SCD patients were Black (91.3% vs. 18.9% in non-SCD, p<0.001). SCD patients had lower prevalence of chronic kidney disease, obesity, diabetes and heart failure. After adjustment for demographics and comorbid conditions, SCD was associated with nearly twice the odds of having a VTE-related hospitalization compared to non-SCD patients (aOR 1.95, 95% CI 1.84–2.07, p<0.001). Despite this higher VTE propensity, in-hospital mortality was similar in SCD and non-SCD groups (1.6% vs. 2.3%; aOR 0.81, 95% CI 0.48–1.38, p=0.448). In-hospital mortality (1.6 % vs 2.3 %), mean LOS (4.92 vs 4.33 days). SCD was not associated with longer LOS (aMD 0.11 days, 95 % CI −0.11–0.35, p = 0.324), and the TOC was modestly lower (aMD −$5,601, 95 % CI −8,926 −2,276, p = 0.001). Predictors of mortality among VTE admissions included arrhythmia, respiratory failure, sepsis, intracranial hemorrhage and acute kidney injury.

Conclusions

In this nationwide analysis, VTE-related hospitalizations in SCD patients accounted for only 0.5% of all VTE admissions. However, SCD patients with VTE were markedly younger, and SCD was associated with nearly double the adjusted odds of a VTE hospitalization compared to patients without SCD. These findings underscore the need for heightened awareness and preventive strategies for VTE in SCD.

Further analysis of recurrent VTE, treatment complication and temporal trends will provide additional insights to inform targeted interventions in this high-risk population.