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Factors associated to mortality in children with critical COVID-19 and multisystem inflammatory syndrome in a

Emmerson C F de Farias1,2, Manoel J C Pavão Junior3, Susan C D de Sales3

  • 1Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil. emmersonfariasbrandynew@gmail.com.

Scientific Reports
|March 6, 2024
PubMed

Insights

Critical COVID-19 and MIS-C in children in the Amazon region have high mortality rates. Factors like ARDS and thrombocytopenia are associated with death in critically ill pediatric patients.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • While SARS-CoV-2 is typically mild in children, critical forms like severe COVID-19 and MIS-C can occur.
  • The Amazonian region presents unique challenges for healthcare access and outcomes.

Purpose of the Study:

  • To describe the characteristics of critically ill children with COVID-19 and MIS-C in the Brazilian Amazon.
  • To identify factors associated with in-hospital mortality in this vulnerable pediatric population.

Main Methods:

  • A multicenter prospective cohort study included 266 critically ill children (1 month to 18 years) with COVID-19/MIS-C.
  • In-hospital mortality was the primary outcome, analyzed using multivariable Cox regression, adjusted for PRISMIV score, age, and comorbidities.
  • Data were collected from three tertiary Pediatric Intensive Care Units (PICUs) between April 2020 and May 2023.

Main Results:

  • Overall mortality was high, with 22.5% in the severe COVID-19 group and 21.5% in the MIS-C group.
  • Mortality was significantly associated with higher Vasoactive Inotropic Score (VIS), acute respiratory distress syndrome (ARDS), elevated Erythrocyte Sedimentation Rate (ESR), and thrombocytopenia.
  • The median time to death was within 12 days of hospitalization for both severe COVID-19 and MIS-C patients.

Conclusions:

  • Critically ill children with severe COVID-19 and MIS-C in the Brazilian Amazon face a substantial risk of in-hospital mortality.
  • Prompt recognition and management of complications such as ARDS and coagulopathies are crucial for improving outcomes.

Keywords:
Child healthIntensive Care UnitMortalityPediatricRisk factorSARS-CoV-2 virus

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