Association Between COVID-19 and Severity of Illness for Children With Hyperglycemic Crisis

Area of Science:

• Pediatric Endocrinology
• Critical Care Medicine
• Infectious Disease Epidemiology

Background:

• The COVID-19 pandemic has been associated with increased ICU admissions for pediatric hyperglycemic crisis (HGC).
• HGC encompasses diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome, and hyperosmolar ketoacidosis.

Purpose of the Study:

• To determine if the severity of hyperglycemic crisis (HGC) in children increased from the prepandemic period to the first two years of the COVID-19 pandemic.
• To analyze trends in ICU admissions and other critical care outcomes for pediatric HGC during the pandemic.

Main Methods:

• A retrospective study analyzed data from children (≤18 years) hospitalized with HGC between March 2017 and February 2022.
• Pre-COVID-19 years (March 2017-February 2020) were compared to COVID-19 Year 1 (March 2020-February 2021) and Year 2 (March 2021-February 2022).
• Primary outcome was ICU admission; secondary outcomes included mortality, length of stay, cost, and need for mechanical ventilation or vasoactive support.

Main Results:

• Out of 46,425 HGC admissions, 43.2% resulted in ICU admission.
• Children admitted during COVID-19 Year 1 (OR 1.31) and Year 2 (OR 1.17) had significantly higher odds of ICU admission compared to prepandemic.
• While some secondary outcomes indicated increased severity, these associations were not consistent, and mortality rates did not differ.

Conclusions:

• Pediatric patients experiencing HGC showed increased illness severity during the COVID-19 pandemic, a trend sustained over two years.
• Factors like social distancing measures and SARS-CoV-2 variants did not significantly alter the link between HGC and heightened ICU care requirements.