Asthma and overt stroke in children with sickle cell disease: a multicenter pediatric cohort study in French Guiana

BACKGROUND: Stroke remains one of the most severe complications of sickle cell disease (SCD) in children. Although asthma is increasingly recognized as a clinical marker of SCD severity, its association with cerebrovascular complications remains insufficiently characterized. We aimed to evaluate the association between physician-documented asthma and overt stroke in children with SCD and to explore the associations of ferritin levels and continuity of care with overt stroke. METHODS: We conducted a multicenter observational cohort study including 175 children with confirmed SCD followed in three public hospitals in French Guiana between January 2012 and December 2022. Overt stroke was defined as a clinically documented neurological deficit lasting > 24 h and confirmed by brain MRI. Asthma status, ferritin levels, and continuity of care, defined as attendance at ≥ 75% of scheduled routine visits during a 12-month period, were assessed. Multivariable penalized logistic regression was used to estimate adjusted associations with overt stroke. RESULTS: Twenty-four children (13.7%) had a history of overt stroke. Asthma was significantly more frequent among children with stroke than among those without stroke (41.7% vs. 16.6%; unadjusted OR 3.60; 95% CI 1.44-9.02). All 175 children had complete data for the covariates included in the adjusted multivariable analysis. In multivariable analysis, asthma remained associated with higher odds of overt stroke (adjusted OR 3.05; 95% CI 1.12-8.31). Ferritin showed a non-significant trend toward higher odds of stroke (adjusted OR 1.58 per SD increase; 95% CI 0.99-2.63). Irregular continuity of care also showed a non-significant increase in the odds of stroke (adjusted OR 2.10; 95% CI 0.88-5.02). All 175 children were included in the adjusted multivariable analysis. CONCLUSIONS: Physician-documented asthma remained associated with higher odds of overt stroke after adjustment in this multicenter pediatric SCD cohort. Ferritin levels and irregular continuity of care showed non-significant exploratory trends. These findings suggest that asthma may identify a subgroup of children with SCD requiring closer clinical assessment. Prospective studies are needed to confirm this association and clarify its clinical significance.