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. 2025 Feb;114(2):325-333.
doi: 10.1111/ejh.14342. Epub 2024 Nov 5.

Biomarkers to Differentiate Acute Chest Syndrome From Vaso-Occlusive Crisis in Children With Sickle Cell Disease

Karen Wang  1 , Nelida Olave  2 , Saurabh Aggarwal  3 , Joo-Yeun Oh  4 , Rakesh P Patel  4 , A K M Fazlur Rahman  5 , Jeffrey Lebensburger  2 , Ammar Saadoon Alishlash  2
Affiliations

Biomarkers to Differentiate Acute Chest Syndrome From Vaso-Occlusive Crisis in Children With Sickle Cell Disease

Karen Wang et al. Eur J Haematol. 2025 Feb.

Abstract

Background: Acute Chest Syndrome (ACS) is the leading cause of death in children with sickle cell disease (SCD) in the US-about half of the children who develop ACS present initially with pain.

Methods: Here, we studied biomarkers to differentiate ACS from vaso-occlusive crises (VOC) in children with SCD who presented with pain to the emergency department (ED). We conducted a prospective cohort study of consecutive patients who presented to the ED with pain and were discharged with ACS or VOC between March, 2017 and February, 2020.

Results: We identified 7 patients with ACS and 19 patients with VOC. The two groups were comparable in age and sex. All patients with ACS had asthma versus 42% of the VOC group. The ACS group had lower weight and BMI z-scores. Patients with ACS compared to VOC had significantly higher respiratory rates, lower O2 saturation, and longer hospital stays. They also had higher white blood cell count, glucose level (> 99 mg/dL), anion gap (> 9 mEq/L), sPLA2 (> 7 pg/mL), IFN-γ (> 17.8 pg/mL), IL-10 (1.54 pg/mL), and IL-12 (> 0.5 pg/mL) levels.

Conclusions: We identified biomarkers associated with ACS development in children with SCD presenting with pain that allow for earlier ACS interventions to reduce mortality and morbidity.

Keywords: biomarkers; diagnosis; pain; pediatric; respiratory; sickle cell disease; vaso‐occlusive crisis acute chest syndrome.

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