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

2024; Nature Portfolio; Volume: 14; Issue: 1 Linguagem: Inglês

10.1038/s41598-024-55065-x

2045-2322

Emmerson Carlos Franco de Farias, Manoel Jaime Castro Pavão Júnior, Susan C D de Sales, L.M.P.P. Do Nascimento, Dalila C.A. Pavão, Anna Paula Santos Pinheiro, Andreza Holanda Oliveira Pinheiro, Marília Cunha Botelho Alves, Kissila Márvia Matias Machado Ferraro, Larisse F.Q. Aires, Luana G. Dias, Mayara Márvia Matias Machado, Michaelle J D Serrão, Raphaella R Gomes, Sara M. P. de Moraes, Gabriella M G Moura, Adriana M B de Sousa, Gabriela C.L. Pontes, Railana D.F.P. Carvalho, Cristiane T.C. Silva, Guilherme Euzébio Lemes, Bruna da C. G. Diniz, Aurimery Gomes Chermont, Kellen F.S. de Almeida, Salma B. Saraty, Mary L F Maia, Miriam R.C. Lima, Patrícia Ismael de Carvalho, Renata de B. Braga, K. Harada, Maria Cleonice Aguiar Justino, Gleice Clemente, Maria Teresa Terreri, Marta Chagas Monteiro,

Respiratory Support and Mechanisms

Abstract SARS-CoV-2 infection in children is usually asymptomatic/mild. However, some patients may develop critical forms. We aimed to describe characteristics and evaluate the factors associated to in-hospital mortality of patients with critical COVID-19/MIS-C in the Amazonian region. This multicenter prospective cohort included critically ill children (1 mo–18 years old), with confirmed COVID-19/MIS-C admitted to 3 tertiary Pediatric Intensive Care Units (PICU) in the Brazilian Amazon, between April/2020 and May/2023. The main outcome was in-hospital mortality and were evaluated using a multivariable Cox proportional regression. We adjusted the model for pediatric risk of mortality score version IV (PRISMIV) score and age/comorbidity. 266 patients were assessed with 187 in the severe COVID-19 group, 79 included in the MIS-C group. In the severe COVID-19 group 108 (57.8%) were male, median age was 23 months, 95 (50.8%) were up to 2 years of age. Forty-two (22.5%) patients in this group died during follow-up in a median time of 11 days (IQR, 2–28). In the MIS-C group, 56 (70.9%) were male, median age was 23 months and median follow-up was 162 days (range, 3–202). Death occurred in 17 (21.5%) patients with a median death time of 7 (IQR, 4–13) days. The mortality was associated with higher levels of Vasoactive Inotropic-Score (VIS), presence of acute respiratory distress syndrome (ARDS), higher levels of Erythrocyte Sedimentation Rate, (ESR) and thrombocytopenia. Critically ill patients with severe COVID-19 and MIS-C from the Brazilian Amazon showed a high mortality rate, within 12 days of hospitalization.