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Vaso-occlusive episodes (VOE) frequently complicate the course for patients with sickle cell disease. These painful episodes may arise without trigger or can be caused by temperature changes, infection, dehydration, or stress. Use of systemic corticosteroids has been considered a possible risk factor for VOE but also has been debated as a possible treatment for VOE (including acute chest syndrome). To address whether outpatient use of systemic corticosteroids is associated with an increase in risk for hospitalization for VOE, investigators analyzed data from a French population-based cohort.
The study included 5151 patients with sickle cell disease (hemoglobin SS disease, Hgb SC disease, Hgb sickle beta-thalassemia) who were hospitalized for VOE between 2010 and 2018. Of these patients, 45% were exposed to corticosteroids at least once; patients served as their own controls: steroid exposure during the month prior to a hospitalization was compared to steroid exposure during other one-month periods. After adjustment for confounders (infection and transfusion), the odds ratio for the association between outpatient corticosteroid exposure and VOE hospitalization was 3.8 (2.6 in patients exposed to hydroxyurea; 4.0 in patients not exposed to hydroxyurea). The median time between corticosteroid prescription and VOE hospitalization was 5 days.
Walter O et al. Risk of vaso-occlusive episode after exposure to corticosteroids in patients with sickle cell disease. Blood 2022 Jun 30; 139:3771. (https://doi.org/10.1182/blood.2021014473)
Comment
These findings suggest an increased risk for VOE among patients with sickle cell disease receiving corticosteroids. Risk for VOE was higher among adults than children, women than men, and hydroxyurea-unexposed than exposed patients. The authors note multiple study limitations, including that risk could not be distinguished by sickle cell genotype or by indication, dose, or duration of the steroid prescription. In addition, the authors could not determine if steroids conferred any beneficial effects (as previously suggested for acute chest syndrome). Nonetheless, these findings are important, as the authors note, given that the risk of steroid use in patients with sickle cell disease had been unknown to many prescribers — 45% of patients in the cohort had been exposed.