Influence of Asthma on Acute Complications of Pediatric Sickle Cell Disease: Data from French Guiana

Background/Objective: Sickle cell disease (SCD) is the most common hemoglobinopathy in French Guiana, exposing children to severe complications such as acute chest syndrome (ACS) and stroke. Asthma, a frequent comorbidity, may worsen these outcomes, but few data are available in the Amazonian context. This study assessed the impact of asthma on acute complications of pediatric SCD. Methods : We conducted a retrospective case-control study (2012–2022) in Cayenne, Saint-Laurent-du-Maroni, and Kourou hospitals. Children aged 6 months–17 years with confirmed SCD (SS, Sβ°, SC, Sβ ⁺ ) and at least one hospitalization were included. Thirty-five asthmatic patients were compared with 140 age- and sex-matched non-asthmatic controls. Analyses combined logistic regression and Bayesian models including clinical, biological, and environmental covariates. Results: Among 390 children (median age 7 years), asthma prevalence was 9.0% (95% CI: 6.1–11.8). Asthma was associated with residence in Kourou, irregular follow-up, elevated ferritin, repeated hospitalizations, ACS (present in all asthmatics; OR=211), and stroke (41.7% vs. 16.6%; OR=3.60). In multivariate Bayesian analysis, asthma remained linked to irregular follow-up (OR=6.74), multiple hospitalizations (OR=13.81), age, and ferritin. The stroke association weakened after adjustment, while ACS persisted as a strong determinant. Conclusion: In pediatric SCD in French Guiana, stroke is the most severe complication. Asthma is not an independent risk factor but indirectly increases morbidity via ACS and repeated hospitalizations. These results support systematic stroke screening with transcranial Doppler and reinforced pneumological follow-up for asthmatic children.