Indications for hospitalisation and predictors of 30-day re-admission of patients with sickle cell disease in Uganda: a retrospective study.

Abstract

Sickle cell disease (SCD) is associated with significant mortality and morbidity, especially in low- and middle-income countries. We determined the indications for hospitalisation and predictors of 30-day re-admission among patients with SCD in Northern and Central Uganda. Retrospective chart review. Mulago National Referral Hospital in Kampala, St. Mary's Hospital Lacor in Gulu and Gulu Regional Referral Hospital in Gulu, Uganda. Patients with confirmed SCD admitted between January 2020 and January 2025 were included. Primary outcome: indication for hospitalisation. rate and predictors of 30-day hospital re-admission. Socio-demographic, clinical history and hospitalisation data were extracted using a pretested data extraction tool. We enrolled 505 patients, accounting for 714 hospital admissions, with a mean age of 8.1±6.2 years. Most participants (n=489, 96.8%) had less than four admissions per year, with a median of 1 admission (IQR: 0-2). The most common indications for hospitalisation were infection (n=375, 52.5%), painful crisis (n=366, 51.3%) and anaemia (n=186, 26.1%). Malaria was the most prevalent infection (n=244, 65%). The median length of hospital stay was 4 days (IQR: 3-6), with a 30-day re-admission rate of 6.9% (n=49). Admission with painful crisis (adjusted OR (AOR): 0.45, 95% CI: 0.23 to 0.89, p=0.021), receiving a blood product (AOR: 0.32, 95% CI: 0.16 to 0.66, p=0.002) and having four or more admissions per year (AOR: 0.84, 95% CI: 0.04 to 0.17, p<0.001) were inversely associated with re-admission within 30 days of last admission. Infections, especially malaria, and painful crises were the leading causes of hospitalisation among Ugandan patients with SCD. Frequent admissions, painful crises and blood transfusions were associated with lower 30-day re-admission risk. There is an urgent need to strengthen malaria prevention strategies and optimise access to disease-modifying therapy, such as hydroxyurea, to improve patient outcomes.