Infectious complications after surgical splenectomy in children with sickle cell disease

OBJECTIVE: To evaluate the frequency of infectious complications in children with sickle cell disease (SCD) after surgical splenectomy for acute splenic sequestration crisis. METHODS: Retrospective cohort of children with SCD who were born after 2002 and were regularly monitored until July 2013. Patients were divided into two groups: cases (children with SCD who underwent surgical splenectomy after an episode of splenic sequestration) and controls (children with SCD who did not have splenic sequestration and surgical procedures), in order to compare the frequency of invasive infections (sepsis, meningitis, bacteremia with positive blood cultures, acute chest syndrome and/or pneumonia) by data collected from medical records. Data were analyzed by descriptive statistical analysis. RESULTS: 44 patients were included in the case group. The mean age at the time of splenectomy was 2.6 years (1-6.9 years) and the mean postoperative length of follow-up was 6.1 years (3.8-9.9 years). The control group consisted of 69 patients with a mean age at the initial follow-up visit of 5.6 months (1-49 months) and a mean length of follow-up of 7.2 years (4-10.3 years).All children received pneumococcal conjugate vaccine. No significant difference was observed between groups in relation to infections during the follow-up. CONCLUSIONS: Surgical splenectomy in children with sickle cell disease that had splenic sequestration did not affect the frequency of infectious complications during 6 years of clinical follow-up.研究目的：评估镰状细胞病（Sickle Cell Disease, SCD）患儿因急性脾隔离症（acute splenic sequestration crisis）接受手术脾切除术后感染并发症的发生频率。研究方法：本研究为回顾性队列研究，纳入2002年后出生且于2013年7月前接受定期随访的SCD患儿。将研究对象分为两组：病例组（因脾隔离症发作后接受手术脾切除术（surgical splenectomy）的SCD患儿）与对照组（未发生脾隔离症且未接受外科手术的SCD患儿），通过提取病历数据比较两组侵袭性感染的发生频率，具体感染类型包括败血症（sepsis）、脑膜炎（meningitis）、血培养阳性菌血症（bacteremia with positive blood cultures）、急性胸部综合征（acute chest syndrome）和/或肺炎（pneumonia），数据采用描述性统计学方法进行分析。研究结果：共纳入病例组患者44例，脾切除术时的平均年龄为2.6岁（范围1~6.9岁），术后平均随访时长为6.1年（范围3.8~9.9年）。对照组共69例患者，首次随访时的平均年龄为5.6个月（范围1~49个月），平均随访时长为7.2年（范围4~10.3年）。所有患儿均接种了肺炎球菌结合疫苗（pneumococcal conjugate vaccine）。随访期间两组的感染发生情况无显著差异。研究结论：镰状细胞病患儿因脾隔离症接受手术脾切除术后，在6年的临床随访期间感染并发症的发生频率未受影响。