Journal article - Review
Prevention and Management of Acute Chest Syndrome Without Automated Red Cell Exchange Among Patients With Sickle Cell Disease Not Requiring ICU Care: A Systematic Review and Network Meta-Analysis
European journal of haematology
19 Mar 2026
PMID: 41857793
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Acute chest syndrome (ACS) is a severe complication of sickle cell disease (SCD) associated with significant morbidity and mortality, necessitating optimized prevention and management strategies for improved patient outcomes. This review does not evaluate red blood cell exchange, as no randomized controlled trials meeting our inclusion criteria reported outcomes for this intervention. A thorough literature review identified interventions for ACS in SCD patients. Seventeen randomized controlled trials (RCTs) underwent assessment using the Cochrane Risk of Bias 2 tool, and a frequentist network meta-analysis was conducted to compare interventions. The use of hydroxyurea and simple transfusion was associated with a lower proportion of patients who developed ACS during the study period compared with standard care (RR: 0.42, 95% CI [0.20–0.86]; RR: 0.31, 95% CI [0.12–0.75], respectively). Intravenous dexamethasone was associated with a lower risk of persistent fever, reduced need for blood transfusion, and shorter durations of both opioid and oxygen therapy, as well as a shorter in-hospital stay (p < 0.01 for all comparisons). When compared with standard care, hydroxyurea was associated with reduced requirement for blood transfusion (RR: 0.17, 95% CI [0.04, 0.73]), with a similar association observed for intravenous dexamethasone (RR: 0.19, 95% CI [0.05, 0.77]). No significant associations were identified between any treatment and rates of hospitalization or readmission. This study offers insights into ACS treatment efficacy and safety in SCD patients. Hydroxyurea and transfusion strategies demonstrated the strongest evidence for reducing acute chest syndrome risk. Corticosteroids were associated with improved inpatient outcomes in predominantly pediatric populations, but concerns regarding potential rebound pain and rehospitalization warrant cautious interpretation. Larger trials are required before routine steroid use can be broadly recommended.
Metrics
1 Record Views
Details
- Title
- Prevention and Management of Acute Chest Syndrome Without Automated Red Cell Exchange Among Patients With Sickle Cell Disease Not Requiring ICU Care: A Systematic Review and Network Meta-Analysis
- Creators
- Mohammed Alsabri - Drexel University, College of MedicineMohammed Al-Tawil - Trier University of Applied SciencesMahmoud Shaaban Abdelgalil - Ain Shams UniversityAhmed Bostamy Elsnhory - Al-Azhar University – GazaAya M. Fayoud - Kafrelsheikh UniversityShrouk Ramadan - Ain Shams UniversityAlaa Ahmed Elshanbary - Alexandria UniversityNoha Samir Mohamed - Al-Azhar UniversityOmar AlAttar - Damascus UniversityReshma Pyala - Medical University of LublinAmira A. Aboali - Alexandria UniversityOmar Ahmed Abdelwahab (Corresponding Author) - Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Publication Details
- European journal of haematology
- Publisher
- Wiley
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:001718654500001
- Scopus ID
- 2-s2.0-105033101998
- Other Identifier
- 991022176476404721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
Source: SDGs in the Output
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Hematology