Hydroxyurea Therapy and Burn Wound Healing in Sickle Cell Disease: A TriNetX Database Study.

Abstract

Sickle cell disease (SCD) is an autosomal recessive disorder characterized by abnormal hemoglobin (Hb), vaso-occlusive crises, and hemolytic anemia. Hydroxyurea has been proven effective in managing SCD but is associated with non-healing skin ulcers. Additionally, its effects on wound healing in burn patients remain unclear. This study investigates the role of hydroxyurea in mortality, wound infection, wound disruption, and sepsis among SCD patients with burn injuries. Using the TriNetX database, cohorts were identified based on ICD-10 codes for adult patients aged 18 years or older diagnosed with SCD, previous burn injury, and hydroxyurea use. Propensity score matching was performed for demographics (age, sex, race, ethnicity), comorbidities that affect wound healing, and clinical variables (burn severity and SCD severity). Mortality, wound infection, wound disruption, and sepsis were assessed at 30 days, three months, and six months post-burn injury. Statistical methods such as chi-square analysis and risk ratio were used, with a statistical significance at p<.05. Hydroxyurea cohort had significantly higher risk for wound healing outcomes such as wound disruption, wound infection, and recurrent sepsis at each time outcome. However, hydroxyurea cohort had significantly lower risk of mortality compared to control group at each time outcome. This study highlights the need of considering hydroxyurea's impact on wound healing when developing treatments for SCD patients with burn injury. Further research is needed to investigate its mechanism in wound healing processes and develop safer treatment alternatives.