Outcomes Among Hospitalized Patients with Acute Chest Syndrome and Concomitant Clinical Depression: A United States Population-Based Cohort Study

Background

Acute chest syndrome is a life-threatening complication of sickle cell disease, seen in both children and adults. Hospitalization and immediate treatment are necessary to prevent morbidity and mortality. Clinical depression is quite prevalent in patients with sickle cell disease, and review of literature reveals association of depression with increased annual emergency department visits, hospitalizations, and blood transfusions in patients with sickle cell disease. Whether this leads to worse outcomes is yet to be ascertained.

Methods

We utilized the 2018-2020 National Inpatient Sample (NIS) Database in conducting a retrospective cohort study. We identified hospitalized patients with acute chest syndrome and concomitant clinical depression using appropriate ICD-10 CM codes. We stratified patients based on whether they had clinical depression during the hospitalization or not. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (OR) for the primary and secondary outcomes. A p value of <0.05 was considered statistically significant. The aim of this study is to investigate the outcomes among hospitalized patients with acute chest syndrome and comorbid clinical depression looking primarily at the in-hospital mortality and hospital length of stay (LOS).

Results

We identified a total of 5271 hospitalized patients with acute chest syndrome, of which 10.72% (565/5271) had comorbid clinical depression. The overall in-hospital mortality among those with acute chest syndrome was 3.70% (195/5271). Among those with clinical depression, the overall in-hospital mortality rate was not significantly higher at 5.31% (30/565) (p=0.385). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, clinical depression among hospitalized patients with acute chest syndrome did not significantly increase the risk for in-hospital mortality (adjusted OR 1.39, 95% confidence interval [CI], 0.49-3.91; p=0.533) or prolong hospital LOS (median LOS 6 days versus 7 days, p=0.631)

Conclusion

Acute chest syndrome continues to be an important cause of hospital admissions in patients with sickle cell disease. Our analysis revealed that clinical depression is commonly encountered in this subset of patients. Clinical depression did not have a statistically significant impact on outcomes including increased in-hospital mortality or prolonged hospital LOS. Prospective studies with large sample sizes are needed to better understand these outcomes.