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Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children

2022; BMJ; Volume: 6; Issue: 1 Linguagem: Inglês

10.1136/bmjpo-2022-001440

2399-9772

Tilmann Schober, Chelsea Caya, Michelle Barton, Ann Bayliss, Ari Bitnun, Jennifer Bowes, Helena Brenes-Chacón, Jared Bullard, Suzette Cooke, Tammie Dewan, Rachel Dwilow, Tala El Tal, Cheryl Foo, Peter Gill, Behzad Haghighi Aski, Fatima Kakkar, Janell Lautermilch, Marie‐Astrid Lefebvre, Kirk Leifso, Nicole Le Saux, Alison Lopez, Ali Manafi, Joanna Merckx, Shaun K. Morris, Alireza Nateghian, Luc Panetta, Dara Petel, Dominique Piché, Rupeena Purewal, Léa Restivo, Ashley Roberts, Manish Sadarangani, Rosie Scuccimarri, Alejandra Soriano‐Fallas, Sarah Tehseen, Karina A. Top, Rolando Ulloa‐Gutiérrez, Isabelle Viel‐Thériault, Jacqueline Wong, Carmen Yea, E. Ann Yeh, Adriana Yock‐Corrales, Joan Robinson, Jesse Papenburg,

SARS-CoV-2 and COVID-19 Research

To identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection.Multicentre retrospective cohort study.18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May 2021.Children<18 years of age hospitalised for symptomatic PCR-positive SARS-CoV-2 infection, including PCR-positive multisystem inflammatory syndrome in children (MIS-C).Severity on the WHO COVID-19 Clinical Progression Scale was used for ordinal logistic regression analyses.We identified 403 hospitalisations. Median age was 3.78 years (IQR 0.53-10.77). At least one comorbidity was present in 46.4% (187/403) and multiple comorbidities in 18.6% (75/403). Eighty-one children (20.1%) met WHO criteria for PCR-positive MIS-C. Progression to WHO clinical scale score ≥6 occurred in 25.3% (102/403). In multivariable ordinal logistic regression analyses adjusted for age, chest imaging findings, laboratory-confirmed bacterial and/or viral coinfection, and MIS-C diagnosis, presence of a single (adjusted OR (aOR) 1.90, 95% CI 1.13 to 3.20) or multiple chronic comorbidities (aOR 2.12, 95% CI 1.19 to 3.79), obesity (aOR 3.42, 95% CI 1.76 to 6.66) and chromosomal disorders (aOR 4.47, 95% CI 1.25 to 16.01) were independent risk factors for severity. Age was not an independent risk factor, but different age-specific comorbidities were associated with more severe disease in age-stratified adjusted analyses: cardiac (aOR 2.90, 95% CI 1.11 to 7.56) and non-asthma pulmonary disorders (aOR 3.07, 95% CI 1.26 to 7.49) in children<12 years old and obesity (aOR 3.69, 1.45-9.40) in adolescents≥12 years old. Among infants<1 year old, neurological (aOR 10.72, 95% CI 1.01 to 113.35) and cardiac disorders (aOR 10.13, 95% CI 1.69 to 60.54) were independent predictors of severe disease.We identified risk factors for disease severity among children hospitalised for PCR-positive SARS-CoV-2 infection. Comorbidities predisposing children to more severe disease may vary by age. These findings can potentially guide vaccination programmes and treatment approaches in children.