TY - JOUR
T1 - Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children
AU - Schober, Tilmann
AU - Caya, Chelsea
AU - Barton, Michelle
AU - Bayliss, Ann
AU - Bitnun, Ari
AU - Bowes, Jennifer
AU - Brenes-Chacon, Helena
AU - Bullard, Jared
AU - Cooke, Suzette
AU - Dewan, Tammie
AU - Dwilow, Rachel
AU - El Tal, Tala
AU - Foo, Cheryl
AU - Gill, Peter
AU - Haghighi Aski, Behzad
AU - Kakkar, Fatima
AU - Lautermilch, Janell
AU - Lefebvre, Marie Astrid
AU - Leifso, Kirk
AU - Le Saux, Nicole
AU - Lopez, Alison
AU - Manafi, Ali
AU - Merckx, Joanna
AU - Morris, Shaun K.
AU - Nateghian, Alireza
AU - Panetta, Luc
AU - Petel, Dara
AU - Piché, Dominique
AU - Purewal, Rupeena
AU - Restivo, Lea
AU - Roberts, Ashley
AU - Sadarangani, Manish
AU - Scuccimarri, Rosie
AU - Soriano-Fallas, Alejandra
AU - Tehseen, Sarah
AU - Top, Karina A.
AU - Ulloa-Gutierrez, Rolando
AU - Viel-Theriault, Isabelle
AU - Wong, Jacqueline
AU - Yea, Carmen
AU - Yeh, Ann
AU - Yock-Corrales, Adriana
AU - Robinson, Joan L.
AU - Papenburg, Jesse
N1 - Publisher Copyright:
©
PY - 2022/8/1
Y1 - 2022/8/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85135988006&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85135988006&partnerID=8YFLogxK
U2 - 10.1136/bmjpo-2022-001440
DO - 10.1136/bmjpo-2022-001440
M3 - Article
C2 - 36053578
AN - SCOPUS:85135988006
SN - 2399-9772
VL - 6
JO - BMJ Paediatrics Open
JF - BMJ Paediatrics Open
IS - 1
M1 - e001440
ER -
