Effect of corticosteroids on haemoglobinuria resolution among children with blackwater fever at Soroti regional referral hospital, Uganda: a retrospective cohort study

BACKGROUND: Corticosteroids are sometimes used in clinical practice in the treatment of blackwater fever (BWF), a complication of severe malaria, despite limited evidence of benefit. This study aimed to compare the time to haemoglobinuria resolution between children with BWF who received corticosteroids and those who did not, and determine if corticosteroid use significantly influences this outcome. METHODS: This was a retrospective cohort study carried out at Soroti Regional Referral Hospital in Soroti, Uganda, among children diagnosed with blackwater fever (BWF), between 1st January 2023 to 31st December 2024. Participants included in the study were 889. Time to haemoglobinuria resolution was determined using the Kaplan-Meier survival function and compared using log rank test. Predictors of time to haemoglobinuria resolution were determined using an extended cox proportional hazard model, with results expressed as adjusted hazard ratios (aHR) and 95% confidence intervals (CI). RESULTS: The median time to haemoglobinuria resolution was 3 days in both the corticosteroid and non-corticosteroid groups. Corticosteroid use was not significantly associated with time to haemoglobinuria resolution (aHR: 0.90; 95% CI 0.75-1.07, p = 0.239). The predictors of time to haemoglobinuria resolution were: antibiotic use (aHR: 0.68; 95% CI 0.58-0.81, p < 0.001), blood transfusion (specifically for those who received transfusions twice [aHR: 0.78; 95% CI 0.62-0.97, p = 0.024], three times [aHR: 0.59; 95% CI 0.40-0.88, p = 0.010], and four times [aHR: 0.36; 95% CI 0.24-0.53, p < 0.001]), presence of jaundice (aHR: 1.49; 95% CI 1.14-1.94, p = 0.003), and administration of normal saline (aHR: 0.57, 95% CI 0.45-0.74, p < 0.001). CONCLUSION: Corticosteroid use did not accelerate haemoglobinuria resolution in children with blackwater fever, supporting current WHO guidance against their use. These findings suggest limited benefit of corticosteroids in BWF management.