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Risk factors for severe disease in children hospitalized with SARS-CoV-2 infection in China: a retrospective cohort
Yan Wang1, Ye Song1,2, Binhui Zhu1
1Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, P.R. China.
Insights
Younger children with comorbidities and neurological signs face a higher risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These factors are key indicators for severe disease in pediatric COVID-19 cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, emerging in 2019, has become a global health concern.
- While generally mild in children, SARS-CoV-2 can cause severe illness in a subset of pediatric patients.
- Understanding risk factors for severe COVID-19 in children is crucial for clinical management and public health strategies.
Purpose of the Study:
- To identify risk factors associated with severe disease in children hospitalized with SARS-CoV-2 infection.
- To analyze these risk factors specifically in the post-Omicron period.
Main Methods:
- A retrospective cohort study was conducted.
- Data from 164 children under 15 hospitalized with SARS-CoV-2 infection between December 2022 and January 2023 were analyzed.
- Multivariable logistic regression was employed to determine independent risk factors for severe disease.
Main Results:
- Younger age (OR: 0.702), presence of comorbidities (OR: 9.042), and neurological signs (OR: 217.21) were identified as independent risk factors for severe SARS-CoV-2 infection.
- Children with severe disease had a significantly higher prevalence of comorbidities (30% vs. 10.7%) and neurological manifestations (91% vs. 27.5%) compared to those with non-severe disease.
- Disease severity did not significantly differ by sex or vaccination status.
Conclusions:
- Younger children, those with comorbidities, and children presenting with neurological manifestations are at increased risk for severe SARS-CoV-2 infection.
- These findings highlight the importance of vigilant monitoring and early intervention for high-risk pediatric patients.
- Limitations include a short study duration, uniform vaccine types, and absence of variant-specific analysis.
Background:
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread rapidly worldwide since its emergence in 2019. While infections in children are generally mild, severe disease can occur in some rare cases. Herein, we aim to identify risk factors for severe disease in children hospitalized with SARS-CoV-2 infection during the post-Omicron period.
Methods:
This retrospective cohort study was based on a review of the records of children aged under 15 years hospitalized with SARS-CoV-2 infection at a university hospital in Xi'an, China between December 8, 2022, and January 17, 2023. Multivariable logistic regression was applied to identify factors associated with severe disease.
Results:
Of 164 children included in the analysis, 33 had severe disease and 131 had non-severe disease. Disease severity did not differ significantly according to sex or SARS-CoV-2 vaccination status. The prevalence of comorbidities was significantly higher in children with severe disease than in those with non-severe disease (30% [10/33] vs. 10.7% [14/131], p = 0.04). The prevalence of neurological manifestations and multisystem disease were also significantly higher in children with severe disease than in those with non-severe disease (91% [30/33] vs. 27.5% [36/131], p = 0.001; and 64% [21/33] vs. 43.5% [57/131], p = 0.039, respectively). Multivariable logistic regression analysis identified younger age (odds ratio [OR]: 0.702, 95% confidence interval [CI]: 0.551-0.893; p = 0.004), the presence of comorbidities (OR: 9.042, 95% CI: 2.505X-32.645; p = 0.001), and neurological signs (OR: 217.21, 95% CI: 34.988-1348.469; p < 0.001) as independent risk factors for severe disease.
Conclusion:
This single-center retrospective cohort study reveals that younger children with comorbidities and neurological manifestations are at higher risk of developing severe SARS-CoV-2 infection. These findings should be interpreted considering limitations including short study timeframe, homogeneous vaccine types, and lack of variant-specific analyses.
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