Fluid Overload Due To Intravenous Fluid Therapy For Vaso-Occlusive Crisis In Sickle Cell Disease: Incidence And Risk Factors

Intravenous fluid therapy (IV-FT) is routinely used in the treatment of vaso-occlusive crises (VOCs), as dehydration possibly promotes and sustains erythrocyte sickling. Patients with sickle cell disease (SCD) are at risk of developing diastolic dysfunction and fluid overload due to IV-FT. However, data on the adverse effects of IV-FT for VOC is sparse. We aimed to evaluate the incidence and risk factors of fluid overload due to IV-FT in patients with SCD. Consecutive hospitalisations for VOC treated with IV-FT between September 2016 and September 2018 were retrospectively analysed. The median (interquartile range) age was 25 center dot 0 (18 center dot 3-33 center dot 8) years and 65% had a severe genotype (HbSS/HbS beta(0)-thal). Fluid overload occurred in 21% of 100 patients. Hospital stay was longer in patients with fluid overload (6 center dot 0 vs. 4 center dot 0 days, P = 0 center dot 037). A positive history of fluid overload (P = 0 center dot 017), lactate dehydrogenase level (P = 0 center dot 011), and top-up transfusion during admission (P = 0 center dot 005) were independently associated with fluid overload occurrence. IV-FT was not reduced in 86% of patients despite a previous history of fluid overload. Fluid overload is frequently encountered during IV-FT for VOC. IV-FT is often not adjusted despite a positive history of fluid overload or when top-up transfusion is indicated, emphasising the need for more awareness of this complication and a personalised approach.