Sickle Cell Trait, Rhabdomyolysis, and Mortality among U.S. Army Soldiers

BACKGROUND

Studies have suggested that sickle cell trait elevates the risks of exertional rhabdomyolysis and death. We conducted a study of sickle cell trait in relation to these outcomes, controlling for known risk factors for exertional rhabdomyolysis, in a large population of active persons who had undergone laboratory tests for hemoglobin AS (HbAS) and who were subject to exertional-injury precautions.

METHODS

We used Cox proportional-hazards models to test whether the risks of exertional rhabdomyolysis and death varied according to sickle cell trait status among 47,944 black soldiers who had undergone testing for HbAS and who were on active duty in the U.S. Army between January 2011 and December 2014. We used the Stanford Military Data Repository, which contains comprehensive medical and administrative data on all active-duty soldiers.

RESULTS

There was no significant difference in the risk of death among soldiers with sickle cell trait, as compared with those without the trait (hazard ratio, 0.99; 95% confidence interval [CI], 0.46 to 2.13; P=0.97), but the trait was associated with a significantly higher adjusted risk of exertional rhabdomyolysis (hazard ratio, 1.54; 95% CI, 1.12 to 2.12; P=0.008). This effect was similar in magnitude to that associated with tobacco use, as compared with no use (hazard ratio, 1.54; 95% CI, 1.23 to 1.94; P<0.001), and to that associated with having a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 30.0 or more, as compared with a BMI of less than 25.0 (hazard ratio, 1.39; 95% CI, 1.04 to 1.86; P=0.03). The effect was less than that associated with recent use of a statin, as compared with no use (hazard ratio, 2.89; 95% CI, 1.51 to 5.55; P=0.001), or an antipsychotic agent (hazard ratio, 3.02; 95% CI, 1.34 to 6.82; P=0.008).

CONCLUSIONS

Sickle cell trait was not associated with a higher risk of death than absence of the trait, but it was associated with a significantly higher risk of exertional rhabdomyolysis. (Funded by the National Heart, Lung, and Blood Institute and the Uniformed Services University of the Health Sciences.)

Supported by a grant from the National Heart, Lung, and Blood Institute in collaboration with the Uniformed Services University of the Health Sciences. All data used in the study were provided under a cooperative agreement with the U.S. Army Medical Command.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

The views expressed in this article are those of the authors and do not reflect the views or official policies of the U.S. Government, the Department of Defense, the Defense Health Agency, the Department of the Army, the Uniformed Services University of the Health Sciences, or the U.S. Army Medical Command.

SOURCE INFORMATION

From the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.A.N., L.M.K.); the Consortium for Health and Military Performance, Department of Defense Center of Excellence, and the Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD (P.A.D.); and the U.S. Army Institute of Surgical Research (R.C.), the Extremity Trauma and Amputation Center of Excellence, Center for the Intrepid, Brooke Army Medical Center (O.T.H.), and the Army–Baylor University Graduate Program in Health and Business Administration (V.L.W.), Fort Sam Houston, and the Department of Emergency Medicine, University of Texas Health Science Center at San Antonio (R.C.) — all in San Antonio, TX.

Address reprint requests to Dr. Kurina at the Department of Medicine, Stanford University School of Medicine, 450 Serra Mall, Bldg. 20, Stanford, CA 94305, or at

 


Autor / Fonte:D. Alan Nelson, Ph.D., Patricia A. Deuster, Ph.D., Robert Carter, III, Ph.D., Owen T. Hill, Ph.D., Vickee L. Wolcott, Ph.D., and Lianne M. Kurina, Ph.D. N Engl J Med 2016; 375:435-442August 4, 2016DOI: 10.1056/NEJMoa1516257
Link: http://www.nejm.org/doi/full/10.1056/NEJMoa1516257