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Intravenous Fluid Therapy and Hospital Outcomes for Vaso-Occlusive Episodes in Children, Adolescents, and Young Adults with Sickle Cell Disease
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  • Abraham Haimed,
  • Rebecca Weiss,
  • Soyang Kwon,
  • Rukhmi Bhat,
  • Sherif Badawy
Abraham Haimed
Divison of Hematology Oncology and Stem Cell Transplantation Ann and Robert H Lurie Children’s Hospital of Chicago

Corresponding Author:[email protected]

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Rebecca Weiss
Northwestern University Feinberg School of Medicine
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Soyang Kwon
Northwestern University Feinberg School of Medicine
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Rukhmi Bhat
Divison of Hematology Oncology and Stem Cell Transplantation Ann and Robert H Lurie Children’s Hospital of Chicago
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Sherif Badawy
Divison of Hematology Oncology and Stem Cell Transplantation Ann and Robert H Lurie Children’s Hospital of Chicago
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Abstract

Background: While intravenous fluid (IVF) therapy in patients with sickle cell disease (SCD) admitted for a vaso-occlusive episodes (VOE) can help reduce red blood cell sickling, clinical practice varies across institutions. We examined the relationship between IVF therapy and hospital length of stay (HLOS), as well as adverse events, such as acute chest syndrome (ACS), pediatric intensive care unit (PICU) transfer and 28-day readmission. Methods: This is a single-center retrospective analysis of SCD VOE hospitalizations between January 2015 and April 2020. Patients with SCD, age 0-30, with consecutive hospitalizations for VOE were included. For the first 3 days of each admission, an “IVF ratio” was calculated by dividing actual IVF rate administered by weight-based maintenance IVF (mIVF) rate. Results: A total of 617 hospitalizations for 161 patients were included. Mean HLOS was 5.7 days, (SD 3.9), and mean IVF volume over the first 3 days of admission was 139.6 ml/kg/day (SD 57.8). Multivariate analysis showed that for each additional 0.5 times the mIVF rate, HLOS increased by 0.53 days (P<0.001; 95% CI: 0.609–0.989), but there was no significant association between IVF therapy and adverse events. History of chronic pain was associated with increased odds of readmission (OR, 6.4; 95% CI: 3.93 – 10.52). Conclusions: Despite the theoretical potential for IVF therapy to slow down the sickling process, our findings suggest that increased IVF therapy was associated with prolonged HLOS, which places a burden on patients, families, and the health system.
13 Jun 2023Submission Checks Completed
13 Jun 2023Assigned to Editor
13 Jun 2023Submitted to Pediatric Blood & Cancer
14 Jun 2023Review(s) Completed, Editorial Evaluation Pending
16 Jun 2023Reviewer(s) Assigned
10 Jul 2023Editorial Decision: Revise Major
09 Oct 2023Submission Checks Completed
09 Oct 2023Assigned to Editor
09 Oct 20231st Revision Received
09 Oct 2023Review(s) Completed, Editorial Evaluation Pending
19 Oct 2023Editorial Decision: Revise Minor
30 Oct 20232nd Revision Received
30 Oct 2023Submission Checks Completed
30 Oct 2023Assigned to Editor
30 Oct 2023Review(s) Completed, Editorial Evaluation Pending
30 Oct 2023Reviewer(s) Assigned
10 Nov 2023Editorial Decision: Accept