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Post-discharge outcomes of hospitalized children diagnosed with acute SARS-CoV-2 or MIS-C
Ericka L Fink1,2, Alicia M Alcamo3, Marlina Lovett4
1Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.
Insights
Many children hospitalized with SARS-CoV-2 or MIS-C experience persistent symptoms and functional impairments. Higher inflammation and lower lymphocyte counts at admission may indicate a need for ongoing specialized care.
Area of Science:
- Pediatric Infectious Diseases
- Viral Pathogenesis
- Public Health
Background:
- Hospitalized children with SARS-CoV-2 related conditions face risks of persistent symptoms and functional deficits.
- Multisystem Inflammatory Syndrome in Children (MIS-C) is a serious condition requiring hospitalization.
Purpose of the Study:
- To analyze post-hospital symptoms, healthcare utilization, and outcomes in children previously hospitalized for acute SARS-CoV-2 infection or MIS-C.
- To identify factors associated with recovery and persistent symptoms in pediatric COVID-19 survivors.
Main Methods:
- Prospective, multicenter electronic survey of parents of children under 18 hospitalized between January 2020 and July 2021.
- Primary outcome: parent-reported child recovery status. Secondary outcomes: symptoms, readmissions, health-related quality of life (HRQOL).
- Multivariable logistic regression analyzed associations between variables and recovered status.
Main Results:
- 29.1% of 79 children were not recovered at follow-up (median 43 months post-discharge).
- 67% reported new or persistent symptoms (fatigue, weakness, headache), more common in non-recovered children.
- Higher C-reactive protein and lower lymphocyte counts on admission were associated with non-recovery; 40% had emergency visits, 24% readmissions.
Conclusions:
- Parent-reported recovery in children post-SARS-CoV-2 hospitalization correlates with fewer symptoms and better HRQOL.
- Elevated inflammatory markers (C-reactive protein) and low lymphocyte counts at admission may identify children requiring long-term, multidisciplinary care.
Introduction:
Hospitalized children diagnosed with SARS-CoV-2-related conditions are at risk for new or persistent symptoms and functional impairments. Our objective was to analyze post-hospital symptoms, healthcare utilization, and outcomes of children previously hospitalized and diagnosed with acute SARS-CoV-2 infection or Multisystem Inflammatory Syndrome in Children (MIS-C).
Methods:
Prospective, multicenter electronic survey of parents of children <18 years of age surviving hospitalization from 12 U.S. centers between January 2020 and July 2021. The primary outcome was a parent report of child recovery status at the time of the survey (recovered vs. not recovered). Secondary outcomes included new or persistent symptoms, readmissions, and health-related quality of life. Multivariable backward stepwise logistic regression was performed for the association of patient, disease, laboratory, and treatment variables with recovered status.
Results:
The children [n = 79; 30 (38.0%) female] with acute SARS-CoV-2 (75.7%) or MIS-C (24.3%) had a median age of 6.5 years (interquartile range 2.0-13.0) and 51 (64.6%) had a preexisting condition. Fifty children (63.3%) required critical care. One-third [23/79 (29.1%)] were not recovered at follow-up [43 (31, 54) months post-discharge]. Admission C-reactive protein levels were higher in children not recovered vs. recovered [5.7 (1.3, 25.1) vs. 1.3 (0.4, 6.3) mg/dl, p = 0.02]. At follow-up, 67% overall had new or persistent symptoms. The most common symptoms were fatigue (37%), weakness (25%), and headache (24%), all with frequencies higher in children not recovered. Forty percent had at least one return emergency visit and 24% had a hospital readmission. Recovered status was associated with better total HRQOL [87 (77, 95) vs. 77 (51, 83), p = 0.01]. In multivariable analysis, lower admission C-reactive protein [odds ratio 0.90 (95% confidence interval 0.82, 0.99)] and higher admission lymphocyte count [1.001 (1.0002, 1.002)] were associated with recovered status.
Conclusions:
Children considered recovered by their parents following hospitalization with SARS-CoV-2-related conditions had less symptom frequency and better HRQOL than those reported as not recovered. Increased inflammation and lower lymphocyte count on hospital admission may help to identify children needing longitudinal, multidisciplinary care.
Clinical Trial Registration:
ClinicalTrials.gov (NCT04379089).
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