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Haematologica

Title:		Effects of corticosteroids in patients with sickle cell disease and acute complications: a systematic review and meta-analysis
Author(s):		Lopinto J; Gendreau S; Berti E; Bartolucci P; Habibi A; Mekontso Dessap A;
Address:		"AP-HP, Hopitaux Universitaires Henri-Mondor, Service de Medecine Intensive Reanimation, F-94010, Creteil, France; Univ Paris Est Creteil, CARMAS, Creteil, F-94010, France. julien.lopinto@aphp.fr. AP-HP, Hopitaux Universitaires Henri-Mondor, Service de Medecine Intensive Reanimation, F-94010, Creteil, France; Univ Paris Est Creteil, CARMAS, Creteil, F-94010, France. Univ Paris Est Creteil, INSERM, IMRB, FHU SENEC, Creteil, F-94010, France; Univ paris Est Creteil, Centre de reference des Syndrome drepanocytaire Majeurs, Unite des Maladies Genetiques du Globule Rouge (UMGGR). AP-HP, Hopitaux Universitaires Henri-Mondor, Service de Medecine Intensive Reanimation, F-94010, Creteil, France; Univ Paris Est Creteil, CARMAS, Creteil, F-94010, France; Univ Paris Est Creteil, INSERM, IMRB, FHU SENEC, Creteil, F-94010, France"
Journal Title:		Haematologica
Year:		2022
Volume:		20220801
Issue:		8
Page Number:		1914 - 1921
DOI:		10.3324/haematol.2021.280105
ISSN/ISBN:		1592-8721 (Electronic) 0390-6078 (Print) 0390-6078 (Linking)
Abstract:		"Whether corticosteroids improve outcome in patients with acute complications of sickle cell disease (SCD) is still debated. We performed a systematic review of the literature with the aim of estimating effects of corticosteroids on the clinical course of vaso-occlusive crisis (VOC) or acute chest syndrome (ACS) in patients with SCD. The primary outcome was transfusion requirement during hospitalization. Studies were identified by search of MEDLINE and CENTRAL database. Three randomized clinical trials (RCT) and three retrospective cohort studies (RCS) were included, involving 3,304 participants and 5,562 VOC or ACS episodes. There was no difference between corticosteroids and standard treatment regarding transfusion requirement overall (odds ratio [OR]=0.98, 95% confidence interval [CI]: 0.38-2.53) but there was a significant interaction of the study type (P<0.0001): corticosteroid therapy was associated with a lower risk of transfusion in RCT (OR=0.13, 95% CI: 0.04-0.45) and a higher risk of transfusion in RCS (OR=2.12, 95% CI: 1.33-3.40. In RCT, the length of hospital stay was lower with corticosteroids as compared with standard treatment: mean difference - 24 hours (95% CI: -35 to -14). Corticosteroids were associated with an increased risk of hospital readmission as compared with standard treatment, in RCT, RCS, and the entire cohort: OR=5.91, 95% CI: 1.40-24.83; OR=3.28, 95% CI: 1.46-7.36 and OR=3.21, 95% CI: 1.97-5.24, respectively. Corticosteroids were associated with reduced number of transfusions and length of stay in RCT but not in RCS, with more rehospitalizations overall. Additional RCT should be conducted while minimizing the risk of rehospitalizations"
Keywords:		"Adrenal Cortex Hormones/therapeutic use *Anemia, Sickle Cell/complications/drug therapy Blood Transfusion Humans *Volatile Organic Compounds/therapeutic use;"
Notes:		"MedlineLopinto, Julien Gendreau, Segolene Berti, Enora Bartolucci, Pablo Habibi, Anoosha Mekontso Dessap, Armand eng Meta-Analysis Systematic Review Italy 2022/01/14 Haematologica. 2022 Aug 1; 107(8):1914-1921. doi: 10.3324/haematol.2021.280105"