History of Pain is Associated with Hospitalization and Severe Course of COVID-19 in Children with Sickle Cell Disease

Recurrent pain causes significant morbidity for individuals with sickle cell disease (SCD) and is a marker of mortality. Considering the current pandemic, it's important to understand how COVID-19 impacts individuals with SCD, a medically vulnerable population. We sought to identify factors associated with more severe COVID-19 illness and hospitalization in the SCD population. We established the international SECURE-SCD Registry to collect COVID-19 data in SCD patients. Providers were instructed to report confirmed COVID-19 cases after the disease course was known. Providers reported demographics, prior SCD complications and COVID-19 related hospitalization, severity/management strategies and death. Data were without protected health information. We used multivariable models to estimate the independent effects of age, sex, genotype, SCD-related and non-related comorbidities grouped by organ systems on the outcomes of severe COVID-19 and hospitalization. We defined the pain variable as 0, 1-2 or >2 prior acute care visits (i.e., emergency department visits, hospitalizations) for pain in the last 3 years. As of October 12th, 2020, 366 COVID-19 cases in SCD patients were reported, 41.5% were children and 52.7% were female. Acute pain was the most common presenting symptom of COVID-19 in SCD patients (54.6%), followed by pneumonia (27.0%). Children who had more than 2 acute care visits for pain had a more severe course of COVID-19 (OR=3.964, 95% CI (1.420, 11.065), p=0.03) and required hospitalization (OR=4.641, 95% CI (1.976, 10.900), p=0.006). Children who had 1-2 acute care visits for pain showed no significant association with COVID-19 severity (p=0.73) or hospitalization (p=0.82). In adults, there was no association between with history of frequent SCD pain and COVID outcomes. Pain is the most common presenting symptom of COVID-19 in SCD patients. Further, more than 2 prior acute care visits for pain is associated with severe COVID-19 course and hospitalization in children with SCD and not in adults. This work was supported by Grant 2020079 from the Doris Duke Charitable Foundation.