Association of Congenital and Acquired Cardiovascular Conditions With COVID-19 Severity Among Pediatric Patients in the US
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Published on: May 5, 2018
Louis Ehwerhemuepha1, Bradley Roth2, Anita K Patel3
1Children's Health of Orange County, Orange, California.
Insights
Pediatric patients with prior cardiovascular conditions face a higher risk of severe COVID-19. Cardiac arrest history in children under 12 is linked to increased COVID-19 severity and morbidity.
Area of Science:
- Cardiology
- Pediatric Infectious Diseases
- Public Health
Background:
- Identifying associations between severe COVID-19 and cardiovascular conditions in pediatric patients is crucial for informing treatment strategies.
- Previous research has highlighted the vulnerability of children with underlying health issues to severe infectious diseases.
Purpose of the Study:
- To assess the association between pre-existing cardiovascular conditions and the severity of COVID-19 in pediatric patients.
- To identify specific cardiovascular conditions that may increase the risk of severe outcomes in children infected with SARS-CoV-2.
Main Methods:
- A retrospective cohort study utilized electronic health records from 85 US health systems (March 2020-January 2021).
- Included were pediatric patients (2 months to 17 years) with confirmed COVID-19 or SARS-CoV-2 exposure.
- Logistic regression analysis examined associations between 26 cardiovascular conditions (diagnosed pre-COVID-19) and severe COVID-19 outcomes (need for oxygen or in-hospital death).
Main Results:
- The study analyzed 171,416 pediatric patients, with 9.96% experiencing severe COVID-19.
- Several cardiovascular conditions were significantly associated with severe COVID-19, including cardiac arrest (OR, 9.92), cardiogenic shock (OR, 3.07), and heart surgery (OR, 3.04).
- Pediatric patients with a history of cardiac arrest, particularly those younger than 12 years, showed a disproportionately higher risk of severe COVID-19.
Conclusions:
- Pre-existing cardiovascular conditions are associated with increased severity of COVID-19 in pediatric patients in the US.
- Children younger than 12 years with a history of cardiac arrest may face heightened morbidity from COVID-19.
- These findings underscore the importance of cardiovascular health assessment in pediatric COVID-19 management.
Importance:
Identifying the associations between severe COVID-19 and individual cardiovascular conditions in pediatric patients may inform treatment.
Objective:
To assess the association between previous or preexisting cardiovascular conditions and severity of COVID-19 in pediatric patients.
Design, Setting, And Participants:
This retrospective cohort study used data from a large, multicenter, electronic health records database in the US. The cohort included patients aged 2 months to 17 years with a laboratory-confirmed diagnosis of COVID-19 or a diagnosis code indicating infection or exposure to SARS-CoV-2 at 85 health systems between March 1, 2020, and January 31, 2021.
Exposures:
Diagnoses for 26 cardiovascular conditions between January 1, 2015, and December 31, 2019 (before infection with SARS-CoV-2).
Main Outcomes And Measures:
The main outcome was severe COVID-19, defined as need for supplemental oxygen or in-hospital death. Mixed-effects, random intercept logistic regression modeling assessed the significance and magnitude of associations between 26 cardiovascular conditions and COVID-19 severity. Multiple comparison adjustment was performed using the Benjamini-Hochberg false discovery rate procedure.
Results:
The study comprised 171 416 pediatric patients; the median age was 8 years (IQR, 2-14 years), and 50.28% were male. Of these patients, 17 065 (9.96%) had severe COVID-19. The random intercept model showed that the following cardiovascular conditions were associated with severe COVID-19: cardiac arrest (odds ratio [OR], 9.92; 95% CI, 6.93-14.20), cardiogenic shock (OR, 3.07; 95% CI, 1.90-4.96), heart surgery (OR, 3.04; 95% CI, 2.26-4.08), cardiopulmonary disease (OR, 1.91; 95% CI, 1.56-2.34), heart failure (OR, 1.82; 95% CI, 1.46-2.26), hypotension (OR, 1.57; 95% CI, 1.38-1.79), nontraumatic cerebral hemorrhage (OR, 1.54; 95% CI, 1.24-1.91), pericarditis (OR, 1.50; 95% CI, 1.17-1.94), simple biventricular defects (OR, 1.45; 95% CI, 1.29-1.62), venous embolism and thrombosis (OR, 1.39; 95% CI, 1.11-1.73), other hypertensive disorders (OR, 1.34; 95% CI, 1.09-1.63), complex biventricular defects (OR, 1.33; 95% CI, 1.14-1.54), and essential primary hypertension (OR, 1.22; 95% CI, 1.08-1.38). Furthermore, 194 of 258 patients (75.19%) with a history of cardiac arrest were younger than 12 years.
Conclusions And Relevance:
The findings suggest that some previous or preexisting cardiovascular conditions are associated with increased severity of COVID-19 among pediatric patients in the US and that morbidity may be increased among individuals children younger than 12 years with previous cardiac arrest.
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