Biomarkers ID’d to predict acute chest syndrome in sickle cell disease
Scientists say new markers may help to predict short-term risk of ACS
Certain blood biomarkers of fat dysregulation, inflammation, and red blood cell destruction, known as hemolysis, may be used to predict the short-term risk of acute chest syndrome (ACS) in people with sickle cell disease (SCD).
That’s according to a new study from France, in which scientists identified these biomarkers as predicting ACS among SCD patients within a yearlong follow-up period.
While the findings will still need to be confirmed in larger studies, the researchers believe that such biomarkers, which are easily measured in the lab, could be used to identify patients who are at risk for this serious complication, and improve their eventual outcomes.
“This study demonstrated lipid [fats] and hemolysis parameters easily available, can be used … to predict ACS in the following year,” the researchers wrote. “The validation of these results [is] required to ensure the reproducibility of the developed model.”
The study, “Lipid and hemolysis parameters predicting acute chest syndrome in adulthood with sickle cell disease,” was published in the journal Lipids in Health and Disease.
Acute chest syndrome in sickle cell patients can lead to respiratory failure
Acute chest syndrome, or ACS, a form of lung injury, is a sickle cell disease complication that arises when blood flow in the lungs is blocked and oxygen levels drop, driving an illness similar to pneumonia. Symptoms like fever, chest pain, and breathing difficulties can ultimately progress to respiratory failure among patients.
It’s a common complication, with about half of people with SCD having an ACS episode at some point in their lives, but also a very serious one. ACS is a leading cause of mortality, accounting for about 25% of SCD-related deaths, data has shown.
Standard care for ACS in the hospital includes oxygen supplementation, blood transfusions, and the use of medications.
“The immediate aim of treatment in ACS is to prevent or reverse acute respiratory failure,” the researchers wrote.
Biomarkers to help predict which patients might develop this life-threatening complication before it happens could help to prevent its onset or improve its management, according to the researchers. However, not many such biomarkers have been identified, the team noted.
Some evidence suggests that lipid dysregulation might influence SCD severity and the onset of more serious complications. Inflammation and hemolysis are processes also known to contribute to the disease. As such, blood markers of these processes could potentially serve as biomarkers for complications like ACS.
The immediate aim of treatment in ACS is to prevent or reverse acute respiratory failure.
In this study, the team looked for biomarkers related to these processes that might be used to predict the development of acute chest syndrome over a one-year period in a group of 91 sickle cell patients. Among them, 37 had a prior history of ACS and six had an episode during the year-long follow-up period.
In general, patients with a past history of ACS had higher blood counts of several immune cell types and inflammatory markers, in addition to showing indicators of more severe hemolysis relative to patients without such a history. In terms of lipids, some types were higher in patients with an ACS history, and some were lower.
A few blood biomarkers were found to be predictors of an ACS episode during the one-year observation period. Specifically, c-reactive protein (CRP) — a marker of inflammation — was associated with a higher risk of ACS when found at levels greater than 8.5 mg/L. Bilirubin, an indicator of hemolysis, was similarly associated with ACS risk when found at levels higher than 39 mg/L.
Various forms of cholesterol, a type of lipid, appeared protective against ACS occurrence, with higher levels linked to lower odds that the complication would arise.
Overall, these biomarkers could help doctors predict who is at risk for ACS in the short term, enabling “increased medical monitoring,” the team wrote, noting that all of the measurements taken can be “easily performed in most hospitals.”
Still, they noted the findings from the small analysis will need “to be confirmed in a larger multicenter study.”
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