Asthma-like respiratory phenotype and acute complications among hospitalized children with sickle cell disease: a multicenter matched case–control study in French Guiana

Children with sickle cell disease (SCD) are at high risk of acute complications, particularly acute chest syndrome (ACS) and stroke. Asthma and asthma-like respiratory phenotypes are frequently reported in this population and may contribute to increased morbidity. However, available data remain heterogeneous, especially in tropical settings where diagnostic approaches and healthcare access differ. We conducted a retrospective matched case–control analysis within a multicenter hospital-based cohort between 2012 and 2022 in the three public hospitals of French Guiana. Children aged 6 months to 17 years with SCD who had been hospitalized for at least one acute complication were included. Cases were defined by a clinically diagnosed asthma-like respiratory phenotype documented during routine pediatric follow-up. Each case was matched with four controls without this phenotype by age and sex. Associations with selected clinical complications and healthcare-utilization markers were assessed using classical logistic regression and complementary Bayesian logistic regression models to account for small sample sizes and complete separation. Among 390 hospitalized children with major SCD, 35 had an asthma-like respiratory phenotype, corresponding to a prevalence of 9.0% (95% CI 6.1–11.8). In univariate analyses, this phenotype was associated with increased hospitalizations, higher ferritin levels, irregular follow-up, stroke, and was strongly associated with ACS. In Bayesian multivariable analysis, the strongest associations were observed with ACS and the frequency of hospitalizations. No independent association with stroke was detected after adjustment. In this hospital-based multicenter cohort of children with sickle cell disease, the asthma-like respiratory phenotype was relatively uncommon. Rather than indicating a causal relationship, this phenotype appeared to identify a subgroup of hospitalized children with greater acute morbidity and healthcare needs. Pragmatic respiratory screening may help clinicians detect children requiring closer respiratory and hematological follow-up, particularly in geographically dispersed and resource-limited settings.