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Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children
Tilmann Schober1, Chelsea Caya2, Michelle Barton3
1Department of Pediatrics, McGill University, Montreal, Quebec, Canada.
Insights
Identifying risk factors for severe COVID-19 in children is crucial. Comorbidities like obesity and chromosomal disorders increase severity risk, with age-specific factors also identified.
Area of Science:
- Pediatric infectious diseases
- Epidemiology of viral infections
- Clinical outcomes of SARS-CoV-2 in children
Background:
- Severe outcomes of SARS-CoV-2 (COVID-19) in children are a significant concern.
- Understanding risk factors is essential for targeted interventions and management.
Purpose of the Study:
- To identify independent risk factors for severe disease in children hospitalized with SARS-CoV-2 infection.
- To explore age-specific risk factors for severe COVID-19 in pediatric populations.
Main Methods:
- Multicenter retrospective cohort study involving 18 hospitals across three countries.
- Analysis of 403 hospitalizations of children under 18 with PCR-positive SARS-CoV-2 infection.
- Ordinal logistic regression used to assess severity based on the WHO COVID-19 Clinical Progression Scale.
Main Results:
- Comorbidities, including single or multiple chronic conditions, obesity, and chromosomal disorders, were independent risk factors for severe disease.
- Age was not an independent risk factor, but specific comorbidities showed age-dependent associations with severity.
- Neurological and cardiac disorders in infants, and obesity in adolescents, were significant predictors of severe disease.
Conclusions:
- Several comorbidities are identified as independent risk factors for severe SARS-CoV-2 disease in hospitalized children.
- Age-specific comorbidities influence disease severity, suggesting tailored approaches.
- Findings can inform vaccination strategies and treatment protocols for pediatric COVID-19.
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.
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