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Pre-existing Immunocompromising Conditions and Outcomes of Acute COVID-19 Patients Admitted for Pediatric Intensive
Courtney M Rowan1, Brenna LaBere2,3, Cameron C Young4
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.
Insights
Pre-existing immunocompromising conditions (ICCs) in pediatric intensive care patients with COVID-19 were linked to worse outcomes, including higher mortality. However, most survived and were discharged without new severe morbidities.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Immunology
Background:
- Acute coronavirus disease 2019 (COVID-19) can present with varying severity in children.
- Immunocompromising conditions (ICCs) may influence disease presentation and outcomes.
- Understanding the impact of ICCs in pediatric intensive care is crucial for managing severe COVID-19.
Purpose of the Study:
- To investigate the association between pre-existing immunocompromising conditions (ICCs) and the clinical presentation of pediatric patients with acute COVID-19.
- To determine if ICCs impact the outcomes of children admitted to the pediatric intensive care unit (PICU) for severe COVID-19.
Main Methods:
- A national case series utilizing the Overcoming COVID-19 surveillance registry.
- Inclusion criteria: Patients under 21 years old admitted to the PICU for acute COVID-19 between March 2020 and December 2021.
- Data collected on patient demographics, ICCs, clinical presentation, and in-hospital outcomes.
Main Results:
- Of 1274 patients, 105 (8.2%) had ICCs, most commonly hematologic malignancies and primary immunodeficiencies.
- Patients with ICCs were older and had more renal conditions but similar admission severity compared to those without ICCs.
- In-hospital mortality was higher (11.4% vs. 4.6%) and hospitalization longer in patients with ICCs (P = .005 and P = .01, respectively).
- Bacterial coinfection was more frequent in ICC patients with life-threatening COVID-19.
Conclusions:
- Pre-existing immunocompromising conditions are associated with worse clinical outcomes in pediatric patients with severe acute COVID-19 requiring intensive care.
- Despite increased mortality risk, the majority of pediatric patients with ICCs survived and were discharged without new severe morbidities.
- Findings highlight the importance of monitoring and tailored care for immunocompromised children with COVID-19.
Background:
We aimed to determine if pre-existing immunocompromising conditions (ICCs) were associated with the presentation or outcome of patients with acute coronavirus disease 2019 (COVID-19) admitted for pediatric intensive care.
Methods:
Fifty-five hospitals in 30 US states reported cases through the Overcoming COVID-19 public health surveillance registry. Patients <21 years admitted 12 March 2020-30 December 2021 to the pediatric intensive care unit (PICU) or high-acuity unit for acute COVID-19 were included.
Results:
Of 1274 patients, 105 (8.2%) had an ICC, including 33 (31.4%) hematologic malignancies, 24 (22.9%) primary immunodeficiencies and disorders of hematopoietic cells, 19 (18.1%) nonmalignant organ failure with solid-organ transplantation, 16 (15.2%) solid tumors, and 13 (12.4%) autoimmune disorders. Patients with ICCs were older, had more underlying renal conditions, and had lower white blood cell and platelet counts than those without ICCs, but had similar clinical disease severity upon admission. In-hospital mortality from COVID-19 was higher (11.4% vs 4.6%, P = .005) and hospitalization was longer (P = .01) in patients with ICCs. New major morbidities upon discharge were not different between those with and without ICC (10.5% vs 13.9%, P = .40). In patients with ICCs, bacterial coinfection was more common in those with life-threatening COVID-19.
Conclusions:
In this national case series of patients <21 years of age with acute COVID-19 admitted for intensive care, existence of a prior ICCs were associated with worse clinical outcomes. Reassuringly, most patients with ICCs hospitalized in the PICU for severe acute COVID-19 survived and were discharged home without new severe morbidities.
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