COVID-19 clinical outcomes in pediatrics: Comparison between immunocompromised and immunocompetent patients in...

Pediatric patients generally present less severe COVID-19 compared with adults; however, clinical outcomes in immunosuppressed children remain heterogeneous and controversial. Some studies suggest a higher risk of complications, whereas others propose that immunosuppression could attenuate the exaggerated inflammatory response associated with severe disease.

To compare the clinical outcomes of immunosuppressed and immunocompetent pediatric patients hospitalized with COVID-19 in a highcomplexity center in Colombia during the pandemic.

A retrospective cohort study was conducted including patients under 18 years of age hospitalized with confirmed COVID-19 between 2020 and 2023. Clinical characteristics and outcomes were compared between both groups. Descriptive statistics were used, along with chi square or Fisher’s exact tests for categorical variables, and Student’s t test or MannWhitney U test for continuous variables depending on their distribution, with significance set at p < 0.05.

A total of 705 patients were analyzed: 124 (17.6%) immunosuppressed and 581 (82.4%) immunocompetent. Immunosuppressed patients had a higher median age (10 vs. 2 years) and higher mortality (4.03% vs. 2.1%; p < 0.001). In contrast, immunocompetent patients more frequently required intubation upon admission (4.6% vs. 0.8%; p = 0.02) and had a longer hospital stay (6 vs. 5 days; p = 0.04). Renal failure was more common among immunosuppressed patients (2.4% vs. 0.3%; p = 0.04).

Immunosuppressed pediatric patients did not show greater acute clinical severity in terms of critical care requirements; however, they presented higher mortality. These findings highlight the variability of outcomes according to immunological status and underscore the need for further studies to identify risk factors and potential protective mechanisms in the pediatric population with COVID-19.