Clinical Spectrum and Factors Associated With Recurrent Acute Chest Syndrome Among Children With Sickle Cell Disease at a Tertiary Hospital in Benin City, Nigeria.

Background: Acute chest syndrome (ACS) is a major cause of morbidity and mortality among children with sickle cell disease (SCD), particularly in sub-Saharan Africa. Recurrent episodes of ACS may contribute to progressive pulmonary complications and prolonged healthcare utilization. However, data on the clinical characteristics and factors associated with recurrent ACS among children in Nigeria are limited. Objective: To describe the clinical spectrum of acute chest syndrome (ACS) and identify factors associated with recurrent ACS among children with SCD at the University of Benin Teaching Hospital, Benin City. Methods: This hospital-based retrospective cross-sectional study included 78 pediatric patients aged 6 months to 18 years with confirmed SCD and a history of ACS. Sociodemographic, clinical, laboratory, and treatment data were obtained through interviews with caregivers and review of clinical records. Recurrent ACS was defined as 2 or more documented lifetime episodes. Associations were assessed using univariable and multivariable logistic regression with statistical significance set at p <0.05. Results: The median age was 9.0 years (IQR 6.0–13.0), with a nearly equal sex distribution. Recurrent ACS occurred in 46.2% of the patients. Chest pain (80.8%), cough (75.6%), and fever (57.7%) were the predominant presenting features, while 92.3% had oxygen saturation ≤ 94%. A preceding vaso-occlusive crisis occurred in 60.3% of the episodes. The main radiological findings were pulmonary infiltrates (44.9%) and consolidation (30.1%). Hydroxyurea was used by 65.4% of the participants. Univariable analysis showed an association between hypoxemia and recurrence; however, this was not sustained after adjustment (aOR 0.22,95% CI: 0.04-1.12; p=0.069). All patients received oxygen therapy and exchange blood transfusion. No independent association was found for recurrent ACS. Conclusion: In this setting, ACS represents a substantial burden among children with SCD in this setting, with recurrence occurring in nearly half of affected children. Early recognition, routine monitoring of oxygen saturation, optimized disease-modifying therapy, adherence monitoring, and larger multicenter studies are needed to improve prevention and risk stratification of recurrence.