Predictors of Acute Chest Syndrome Following Vaso-Occlusive Crisis in Pediatric Sickle Cell Disease

Résumé fourni par la source

Acute chest syndrome (ACS) is a frequent and potentially life-threatening complication of sickle cell disease (SCD), often developing during hospitalization for vaso-occlusive crisis (VOC). Early identification of pediatric patients at risk remains challenging, particularly in high-prevalence settings. We conducted a retrospective cohort study of children and adolescents (≤18 years) with confirmed SCD admitted for VOC to Cayenne Hospital Center, French Guiana, between January 2014 and September 2024. ACS occurring during hospitalization or within 7 days of admission was recorded. Multivariable logistic regression was used to identify independent predictors, and model performance was assessed using receiver operating characteristic (ROC) analysis. Among 824 VOC episodes in 190 patients, 239 (29%) were complicated by ACS. Independent predictors of ACS were thoracic or abdominal pain at presentation (adjusted odds ratio [aOR] 2.88, 95% CI 1.45–5.72), prior history of ACS (aOR 2.20, 95% CI 1.28–2.90), and HbSS or Sβ⁰ genotype (aOR 1.91, 95% CI 1.30–2.60). Hydroxyurea use at admission was less frequent among patients who developed ACS. The predictive model showed good discrimination (AUC ~0.90), high specificity (96%), and positive predictive value (85%). These findings support targeted monitoring and early preventive strategies during pediatric VOC admissions.

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