Examining Outcomes for Patients With Sickle Cell Disease Hospitalized for Opioid Overdose

A nationwide analysis examining outcomes among hospitalized patients with opioid overdose and concomitant sickle cell disease (SCD) found no significant difference in in-hospital mortality rates between patients with SCD and those without SCD. Patients with SCD, however, demonstrated more favorable discharge outcomes and were less likely to experience certain severe complications.

SCD, a genetic hematologic disorder characterized by recurrent vaso-occlusive conditions (VOC) and severe pain, often requires opioid therapy. Despite its necessity, opioid prescribing for SCD has been tempered by concerns regarding potential misuse and adverse outcomes, particularly in the context of the opioid epidemic. This study sought to address these concerns by evaluating in-hospital outcomes and complications associated with opioid overdose in patients with SCD compared with non-SCD patients.

Researchers conducted a retrospective, descriptive analysis of the National Inpatient Sample database from 2016 to 2021. The study included 479,175 hospitalized patients with opioid overdose, 1660 of whom had a history of SCD. Using multivariate logistic regression (MLR) and propensity score matching (PSM), the investigators adjusted for demographic, socioeconomic, and clinical factors, including comorbidities. Primary outcomes included in-hospital mortality, while secondary outcomes focused on complications such as invasive mechanical ventilation, anoxic brain damage, and venous thromboembolism (VTE), as well as discharge disposition.

The analysis revealed no statistically significant difference in in-hospital mortality between patients with SCD and without SCD (2.71% vs. 4.5%; adjusted odds ratio [aOR] = 0.67; 95% CI, 0.34-1.31; P = .242). After PSM, this result remained consistent (aOR = 0.66; 95% CI, 0.28-1.58; P = .353). Complication rates varied between groups; non-SCD patients were significantly more likely to experience complications such as mechanical ventilation (22.83% vs. 10.54%, P < .001) and anoxic brain injury (4.79% vs. 1.2%, P = .003). Conversely, patients with SCD had a higher incidence of VTE (4.22% vs. 1.88%, P = .007). Discharge outcomes also favored patients with SCD, with fewer against-medical-advice discharges, more routine discharges, and higher rates of home health care.

“In terms of our primary outcome, our data reveals no significant difference in in-hospital mortality between patients with SCD and patients without SCD admitted for opioid overdoses,” the study authors concluded. “…Evidence from studies such as this may help to decrease undertreatment of VOC pain crises and to improve care for these patients.”

Reference

Bode A, Mumtaz A, Montes OB, et al. Opioid overdose in patients with sickle cell disease, outcomes among hospitalized patients in the United States. Paper presented at: American Society of Hematology Annual Meeting; December 7-10, 2024; San Diego, CA. Accessed November 26, 2024. https://www.hematology.org/meetings/annual-meeting