Predictors of Developing a Complex Course of Osteomyelitis in Patients with Sickle Cell Anaemia

Abstract

Objective: Despite the numerous advances in management strategies, treating osteomyelitis in individuals with sickle cell disease remains a significant challenge, leading to severe long-term consequences. This study aimed to assess the key factors potentially linked to a complex progression of osteomyelitis in patients diagnosed with sickle cell disease. Methods: A cohort of thirty-four patients was identified, and their progress was monitored over a span of twelve months, during a ten-year period (2010-2020). The variables under investigation encompassed demographic and clinical traits, laboratory analyses, imaging data, as well as the strategies employed for treatment. Results: The risk prediction model has pinpointed five factors (severity of sickle cell disease, involvement of lower limbs, presence of bacteraemia, MRI findings, and utilization of surgical debridement) that exhibited an Area Under the Curve (AUC) exceeding 0.7. Causative organisms were identified in 9 out of the total cases, constituting 26.47% of the patient cohort. Among the 34 patients, 17 displayed a severe course of sickle cell disease (AUC 7.88), with MRI being highlighted as a valuable contributing factor (AUC 7.88). Furthermore, thirteen patients (38.2%) underwent surgical debridement, a procedure that yielded a statistically significant P-value of 0.012 and an AUC of 0.714. Conclusion: Osteomyelitis within the context of severe sickle cell disease, particularly when accompanied by lower extremity infection, bacteraemia, and positive MRI findings, and necessitating surgical debridement, emerges as a cluster of risk factors predisposing individuals to osteomyelitis relapse and a more intricate disease trajectory. Keywords: Sickle cell disease, Osteomyelitis, Disease Severity, Debridement, bacteraemia