Dataset Information

Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children.

ABSTRACT:

Objective

To identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection.

Design

Multicentre retrospective cohort study.

Setting

18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May 2021.

Patients

Children<18 years of age hospitalised for symptomatic PCR-positive SARS-CoV-2 infection, including PCR-positive multisystem inflammatory syndrome in children (MIS-C).

Main outcome measure

Severity on the WHO COVID-19 Clinical Progression Scale was used for ordinal logistic regression analyses.

Results

We identified 403 hospitalisations. Median age was 3.78 years (IQR 0.53-10.77). At least one comorbidity was present in 46.4% (187/403) and multiple comorbidities in 18.6% (75/403). Eighty-one children (20.1%) met WHO criteria for PCR-positive MIS-C. Progression to WHO clinical scale score ≥6 occurred in 25.3% (102/403). In multivariable ordinal logistic regression analyses adjusted for age, chest imaging findings, laboratory-confirmed bacterial and/or viral coinfection, and MIS-C diagnosis, presence of a single (adjusted OR (aOR) 1.90, 95% CI 1.13 to 3.20) or multiple chronic comorbidities (aOR 2.12, 95% CI 1.19 to 3.79), obesity (aOR 3.42, 95% CI 1.76 to 6.66) and chromosomal disorders (aOR 4.47, 95% CI 1.25 to 16.01) were independent risk factors for severity. Age was not an independent risk factor, but different age-specific comorbidities were associated with more severe disease in age-stratified adjusted analyses: cardiac (aOR 2.90, 95% CI 1.11 to 7.56) and non-asthma pulmonary disorders (aOR 3.07, 95% CI 1.26 to 7.49) in children<12 years old and obesity (aOR 3.69, 1.45-9.40) in adolescents≥12 years old. Among infants<1 year old, neurological (aOR 10.72, 95% CI 1.01 to 113.35) and cardiac disorders (aOR 10.13, 95% CI 1.69 to 60.54) were independent predictors of severe disease.

Conclusion

We identified risk factors for disease severity among children hospitalised for PCR-positive SARS-CoV-2 infection. Comorbidities predisposing children to more severe disease may vary by age. These findings can potentially guide vaccination programmes and treatment approaches in children.

SUBMITTER: Schober T

PROVIDER: S-EPMC9358955 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Publications

Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children.

Schober Tilmann T Caya Chelsea C Barton Michelle M Bayliss Ann A Bitnun Ari A Bowes Jennifer J Brenes-Chacon Helena H Bullard Jared J Cooke Suzette S Dewan Tammie T Dwilow Rachel R El Tal Tala T Foo Cheryl C Gill Peter P Haghighi Aski Behzad B Kakkar Fatima F Lautermilch Janell J Lefebvre Marie-Astrid MA Leifso Kirk K Le Saux Nicole N Lopez Alison A Manafi Ali A Merckx Joanna J Morris Shaun K SK Nateghian Alireza A Panetta Luc L Petel Dara D Piché Dominique D Purewal Rupeena R Restivo Lea L Roberts Ashley A Sadarangani Manish M Scuccimarri Rosie R Soriano-Fallas Alejandra A Tehseen Sarah S Top Karina A KA Ulloa-Gutierrez Rolando R Viel-Theriault Isabelle I Wong Jacqueline J Yea Carmen C Yeh Ann A Yock-Corrales Adriana A Robinson Joan L JL Papenburg Jesse J

BMJ paediatrics open 20220801 1

<h4>Objective</h4>To identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection.<h4>Design</h4>Multicentre retrospective cohort study.<h4>Setting</h4>18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May 2021.<h4>Patients</h4>Children<18 years of age hospitalised for symptomatic PCR-positive SARS-CoV-2 infection, including PCR-positive multisystem inflammatory syndrome in children (MIS-C).<h4>Main outcome measure</h4>Severity on the WHO COVID- ...[more]

PMID: 36053578

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Project description:ImportanceSevere gastrointestinal (GI) manifestations have been sporadically reported in children with COVID-19; however, their frequency and clinical outcome are unknown.ObjectiveTo describe the clinical, radiological, and histopathologic characteristics of children with COVID-19 presenting with severe GI manifestations to identify factors associated with a severe outcome.Design, setting, and participantsA multicenter retrospective cohort study (February 25, 2020, to January 20, 2021) enrolled inpatient and outpatient children (aged <18 years) with acute SARS-CoV-2 infection, confirmed by positive real-time reverse-transcriptase-polymerase chain reaction on nasopharyngeal swab or fulfilling the US Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children (MIS-C). The study was conducted by pediatricians working in primary care or hospitals in Italy participating in the COVID-19 Registry of the Italian Society of Pediatric Infectious Diseases.Main outcomes and measuresThe occurrence of severe GI manifestations, defined by a medical and/or radiological diagnosis of acute abdomen, appendicitis (complicated or not by perforation and/or peritonitis), intussusception, pancreatitis, abdominal fluid collection, and diffuse adenomesenteritis requiring surgical consultation, occurring during or within 4 to 6 weeks after infection with SARS-CoV-2 infection. Logistic regression was used to estimate odds ratios (ORs) with 95% CIs of factors potentially associated with severe outcomes.ResultsOverall, 685 children (386 boys [56.4%]; median age, 7.3 [IQR, 1.6-12.4] years) were included. Of these children, 628 (91.7%) were diagnosed with acute SARS-CoV-2 infection and 57 (8.3%) with MIS-C. The presence of GI symptoms was associated with a higher chance of hospitalization (OR, 2.64; 95% CI, 1.89-3.69) and intensive care unit admission (OR, 3.90; 95% CI, 1.98-7.68). Overall, 65 children (9.5%) showed severe GI involvement, including disseminated adenomesenteritis (39.6%), appendicitis (33.5%), abdominal fluid collection (21.3%), pancreatitis (6.9%), or intussusception (4.6%). Twenty-seven of these 65 children (41.5%) underwent surgery. Severe GI manifestations were associated with the child's age (5-10 years: OR, 8.33; 95% CI, 2.62-26.5; >10 years: OR, 6.37; 95% CI, 2.12-19.1, compared with preschool-age), abdominal pain (adjusted OR [aOR], 34.5; 95% CI, 10.1-118), lymphopenia (aOR, 8.93; 95% CI, 3.03-26.3), or MIS-C (aOR, 6.28; 95% CI, 1.92-20.5). Diarrhea was associated with a higher chance of adenomesenteritis (aOR, 3.13; 95% CI, 1.08-9.12) or abdominal fluid collection (aOR, 3.22; 95% CI, 1.03-10.0).Conclusions and relevanceIn this multicenter cohort study of Italian children with SARS-CoV-2 infection or MIS-C, 9.5% of the children had severe GI involvement, frequently associated with MIS-C. These findings suggest that prompt identification may improve the management of serious complications.

Project description:BackgroundSequelae post-SARS-CoV-2 infection, including lung and functional impairment, pose a significant challenge post-recovery. We explored the burden and risk factors for post-COVID-19 sequelae in an African population with prevalent comorbidities including tuberculosis (TB) and HIV.MethodsWe conducted an observational cohort study on hospitalised adults with confirmed SARS-CoV-2 infection from 20 March to 06 October 2021 at Chris Hani Baragwanath Academic Hospital, South Africa. We collected data on comorbidities, and COVID-19 severity using the World Health Organization (WHO) clinical progression scale. Prospectively, we followed up all participants within 40-days post-discharge to assess body mass index (BMI), COVID-19 symptoms and quality of life using St George's Respiratory Questionnaire (SGRQ), 6-min walking-test (6MWT), and spirometry. A subsequent in-depth visit assessed plethysmography, diffusing capacity for the lung for carbon monoxide (DLCO), and high-resolution chest-CT.FindingsWe followed up 111 participants, where 65.8% were female, median age 50.5 years, and predominantly black-African (92.8%). Relevant comorbidities included TB disease (18.9%) and HIV infection (36%). SGRQ total scores were elevated in 78.9%, median 6MWT distance was reduced at 300 m (IQR 210-400), and nearly half (49.5%) exhibited spirometry findings below the lower limit of normal (LLN). In-depth pulmonary assessment for 61 participants revealed abnormalities in total lung capacity (31.6% <80% predicted), DLCO (53.4% <80% predicted), and chest-CT (86.7% abnormal). Significant risk factors for individual abnormal outcomes, adjusted for age and sex, were TB disease, HIV with CD4 <200 cells/mm3, BMI <18.5 kg/m2 and >35 kg/m2, and initial COVID-19 severity.InterpretationThis study demonstrates substantial lung and functional morbidity within the first weeks post-COVID-19, particularly in individuals with pre-existing comorbidities including TB, HIV, and low or high BMI. Chest-CT and DLCO show best early potential at reflecting COVID-19-related pathologies.FundingThe Bavarian State Ministry of Science and Arts.

Dataset Information

Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children.

Objective

Design

Setting

Patients

Main outcome measure

Results

Conclusion

Publications

Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children.

Similar Datasets

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