Evaluation of the Potential of Inflammatory and Coagulation Biomarkers as Predictors of Vaso-Occlusive Episodes in Children with Sickle Cell Disease: A Prospective Cohort Study

Background: The primary cause of morbidity among children with sickle cell disease are vaso-occlusive episodes (VOEs). Pathophysiology of VOEs are greatly influenced by systemic inflammation and hypercoagulability. This study evaluated the potential of certain inflammatory markers (CRP, IL-6) and coagulation (D-dimer, fibrinogen) biomarkers as potential early predictors of VOEs in children with Sickle cell disease. Methodology: A 12-month study was conducted on 18 pediatric patients with SCD, aged between the years of 2–18 at a tertiary hematology clinic. Standardized laboratory assays were employed to evaluate the baseline and follow-up blood samples for CRP, IL-6, D-dimer, and fibrinogen levels. All patients were followed up at every three months and also during VOEs. Paired tests, regression models, and ROC curve analysis were used to establish the associations between the biomarker levels, VOE occurrence, severity, and pain scores in children. Results: During the follow-up periods almost half of the patients developed had VOEs. In contrast to baseline levels, the mean biomarker levels during VOEs rose significantly (p<0.001). Compared to patients who were stable, those patients who developed VOEs later showed elevated baseline biomarker levels. Fibrinogen and Ddimer displayed the highest predictive accuracy (AUC≈1.0). followed by CRP and IL-6. Biomarker levels correlated positively with pain score (r>0.96, p<0.01), thereby, establishing the link between biochemical variations and clinical severity. Conclusion: In pediatric SCD the VOE occurrence and severity can be predicted by the elevated baseline and crisis-state levels of CRP, IL-6, D-dimer, and fibrinogen. These biomarkers show potential for early risk assessment and clinical monitoring. To establish clinical cut off values and confirm clinical applicability, larger multicenter studies are needed.