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Gastrointestinal Manifestations in Hospitalized Children With Acute SARS-CoV-2 Infection and Multisystem Inflammatory
Imran A Sayed1, Utpal Bhalala2, Larisa Strom3
1From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado.
Insights
Gastrointestinal issues are common in children hospitalized with COVID-19 and MIS-C. However, these GI manifestations do not increase the risk of critical illness, prolonged hospital stays, or mortality in these pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Critical Care Medicine
Background:
- Gastrointestinal (GI) manifestations are frequently observed in children with acute COVID-19 and multisystem inflammatory syndrome (MIS-C).
- Understanding the incidence and impact of these GI symptoms is crucial for managing pediatric cases of COVID-19 and MIS-C.
Purpose of the Study:
- To determine the incidence of GI manifestations in hospitalized children diagnosed with acute COVID-19 or MIS-C.
- To investigate the association between GI involvement and critical illness, prolonged hospital stay, and mortality in these pediatric populations.
Main Methods:
- A retrospective review was conducted on data from the Viral Infection and Respiratory Illness Universal Study registry.
- The study included hospitalized children with acute COVID-19 or MIS-C between March 2020 and November 2020.
- Multivariable models assessed the association of GI involvement with critical illness, length of stay, and mortality.
Main Results:
- Gastrointestinal involvement was present in 63.3% of the 789 pediatric patients studied.
- Patients with GI involvement were older, and a subset had underlying GI comorbidities.
- Despite the high incidence, GI involvement was not associated with critical illness, prolonged hospitalization, or mortality in either acute COVID-19 or MIS-C.
Conclusions:
- Gastrointestinal symptoms are a common feature in children hospitalized with acute COVID-19 and MIS-C.
- The presence of GI involvement does not appear to be a risk factor for adverse outcomes such as critical illness, extended hospital stays, or death in these pediatric conditions.
Background:
Describe the incidence and associated outcomes of gastrointestinal (GI) manifestations of acute coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in hospitalized children (MIS-C).
Methods:
Retrospective review of the Viral Infection and Respiratory Illness Universal Study registry, a prospective observational, multicenter international cohort study of hospitalized children with acute COVID-19 or MIS-C from March 2020 to November 2020. The primary outcome measure was critical COVID-19 illness. Multivariable models were performed to assess for associations of GI involvement with the primary composite outcome in the entire cohort and a subpopulation of patients with MIS-C. Secondary outcomes included prolonged hospital length of stay defined as being >75th percentile and mortality.
Results:
Of the 789 patients, GI involvement was present in 500 (63.3%). Critical illness occurred in 392 (49.6%), and 18 (2.3%) died. Those with GI involvement were older (median age of 8 yr), and 18.2% had an underlying GI comorbidity. GI symptoms and liver derangements were more common among patients with MIS-C. In the adjusted multivariable models, acute COVID-19 was no associated with the primary or secondary outcomes. Similarly, despite the preponderance of GI involvement in patients with MIS-C, it was also not associated with the primary or secondary outcomes.
Conclusions:
GI involvement is common in hospitalized children with acute COVID-19 and MIS-C. GI involvement is not associated with critical illness, hospital length of stay or mortality in acute COVID-19 or MIS-C.
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