Table 27GRADE table for signs and symptoms of acute kidney injury in patients with an acute painful sickle cell episode

Outcome1
Quality assessmentSummary of findings
No of episodes (no patients)Effect/outcomeQualitya
No. of studiesDesignRisk of biasInconsistencyIndirectnessImprecisionOther considerationsTotalAcute complication
Incidence
1 study (Audard 2010)Retrospective designNNNScN254b11The incidence of acute kidney injury in patients presenting to hospital with a painful sickle cell episode was 4.3%Very low
Clinical sign/symptom: severity of episode (uncomplicated, moderate acute chest syndrome, severe acute chest syndrome)
1 study (Audard 2010)Retrospective designNNNScN254b11The incidence of acute kidney injury was 2.3% (4 episodes) during uncomplicated pain crisis, 6.9% (4 episodes) during moderate acute chest syndrome and 13.6% (3 episodes) during severe acute chest syndrome (p = 0.03)Very low
Laboratory marker: white blood cells (109/litre)
1 study (Audard 2010)Retrospective designNNNScN16111White blood cell count was significantly higher in patients with acute kidney injury (median 11.9) compared with patients without acute kidney injury (median 9.8, p = 0.03)Very low
Laboratory marker: total haemoglobin (g/dl)
1 study (Audard 2010)Retrospective designNNNScN16111Total haemoglobin was significantly lower in patients with acute kidney injury (median 8.2) compared with patients without acute kidney injury (median 8.9, p = 0.04)Very low
Laboratory marker: lactate dehydrogenase (IU/litre)
1 study (Audard 2010)Retrospective designNNNScN16111Lactate dehydrogenase was significantly higher in patients with acute kidney injury (median 453) compared with patients without acute kidney injury (median 325, p = 0.02)Very low
Combination of clinical sign/symptom and laboratory marker: severe acute chest syndrome and aminotransferases (IU/litre)
1 study (Audard 2010)Retrospective designNNSdScN59b6Aspartate aminotransferase (median 275 vs 36) and alanine aminotransferase (median 223 vs 27) levels were significantly higher in patients with severe acute chest syndrome with acute kidney injury compared with patients without acute kidney injury (p < 0.01)Very low
Combination of clinical sign/symptom and laboratory marker: severe acute chest syndrome and bilirubin (μmol/litre)
1 study (Audard 2010)Retrospective designNNSdScN59b6Total bilirubin (median 173 vs 68, p = 0.04) and direct bilirubin (median 100 vs 18, p = 0.03) were significantly higher in patients with severe acute chest syndrome with acute kidney injury compared with patients without acute kidney injuryVery low
Combination of clinical sign/symptom and laboratory marker: severe acute chest syndrome and lactate dehydrogenase (IU/litre)
1 study (Audard 2010)Retrospective designNNSdScN59b6Lactate dehydrogenase was significantly higher in patients with severe acute chest syndrome with acute kidney injury (median 980) compared with patients without acute kidney injury (median 443, p = 0.04)Very low
Combination of clinical sign/symptom and laboratory marker: severe acute chest syndrome and echocardiographic features of pulmonary hypertension
1 study (Audard 2010)Retrospective designNNSdScN59b6Tricuspid regurgitant jet velocity (median 3.6 vs 2.8 m/s) and systolic pulmonary artery pressure (median 67 vs 46 mmHg) were significantly higher and IVC collapse (median 16 vs 0%) and cor pulmonale (5 vs 4) were significantly lower in patients with severe acute chest syndrome with acute kidney injury compared with patients without acute kidney injuryVery low

NB: all outcomes were assessed during hospitalisation

S: serious

N: no serious

a

prospective studies started with a high quality rating and retrospective studies were started with a low quality rating and were downgraded as appropriate

b

number of episodes

c

Downgrade by one level: imprecision was downgraded if there was a wide confidence interval or a small sample size (less than 400 in total)

d

Downgrade by one level: population of patients with severe acute chest syndrome were considered sicker than patients who would generally present to hospital with an acute painful episode.

1

Acute kidney injury in adults defined in three stages. Stage 1 is an increase of serum creatinine of ≥ 26.4 μmol/litre or increase to ≥ 150–200% from baseline (the lowest measurement during the 3 months preceding hospitalisation). Stage 2 is an increase of serum creatinine of >200–300% from baseline. Stage 3 is an increase of serum creatinine to >300% from baseline or ≥ 354 μmol/litre with an acute increase of at least 44 μmol/litre.

From: 2, Evidence review and recommendations

Cover of Sickle Cell Acute Painful Episode
Sickle Cell Acute Painful Episode: Management of an Acute Painful Sickle Cell Episode in Hospital.
NICE Clinical Guidelines, No. 143.
Centre for Clinical Practice at NICE (UK).
Copyright © 2012, National Institute for Health and Clinical Excellence.

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