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. 2023 Dec 1;13(1):21198.
doi: 10.1038/s41598-023-48324-w.

Lactate dehydrogenase and hemolysis index to predict vaso-occlusive crisis in sickle cell disease

Guillaume Feugray  1   2 , Cécile Dumesnil  3 , Maximilien Grall  4 , Ygal Benhamou  5 , Helene Girot  6 , Julie Fettig  6 , Valery Brunel #  6 , Paul Billoir #  7
Affiliations

Lactate dehydrogenase and hemolysis index to predict vaso-occlusive crisis in sickle cell disease

Guillaume Feugray et al. Sci Rep. .

Abstract

Sickle cell disease (SCD) is an inherited hemoglobinopathy disorder associated with chronic hemolysis. A major complication is vaso-occlusive crisis (VOC), associating frequent hospitalization, morbidity and mortality. The aim of this study was to investigate whether hemolysis biomarkers were able to predict VOC risk in adult patients with SCD requiring hospitalization within 1 year. This single-center prospective study included adult patients with SCD at steady state or during VOC. A total of 182 patients with SCD were included, 151 at steady state and 31 during VOC. Among the 151 patients at steady state 41 experienced VOC within 1 year (median: 3.0 months [2.0-6.5]). We observed an increase of lactate dehydrogenase (LDH) (p = 0.01) and hemolysis index (HI) (p = 0.0043) during VOC compared to steady state. Regarding patients with VOC requiring hospitalization, LDH (p = 0.0073) and HI (p = 0.04) were increased. In unadjusted logistic regression, LDH > median (> 260 U/L) (RR = 3.6 [1.29-10.88], p = 0.0098) and HI > median (> 8 UA/L) (RR = 3.13 [1.91-5.33]; p < 0.001) were associated with VOC. The association of LDH > 260 U/L and HI > 12 UA/L presented a sensitivity of 90%, and a specificity of 72.9% to predict VOC. The association of LDH and HI cut-off was able to predict VOC risk in SCD.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flowchart of the study design.
Figure 2
Figure 2
Correlation of hemolysis parameters in all SCD genotypes at steady state (a) and during vaso-occlusive crisis (b). Data are expressed as r Pearson correlation and (p value). RBC, red blood cells; MCV, mean corpuscular volume; MCHC, mean corpuscular hemoglobin concentration; LDH, lactate dehydrogenase; ALP, alkaline phosphate; ASAT, aspartate amino transferase; ALAT, alanine amino transferase; yGT, gamma-glutamyl transferase; HI, Hemolysis Index.
Figure 3
Figure 3
Algorithm to predict vaso-occlusive crisis. LDH, Lactate dehydrogenase; HI, Hemolysis Index; PPV, Positive Predictive Value. NPV, Negative Predictive Value. VOC, Vaso-occlusive crisis. Patients under classification tree is performed when both biomarkers is realized.
See this image and copyright information in PMC

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