Clinical spectrum of COVID-19 and risk factors associated with severity in Spanish children.
COVID-19
Children
Clinical phenotypes
MIS-C
SARS-CoV-2
Severity
Journal
European journal of pediatrics
ISSN: 1432-1076
Titre abrégé: Eur J Pediatr
Pays: Germany
ID NLM: 7603873
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
received:
12
08
2021
accepted:
28
10
2021
revised:
06
10
2021
pubmed:
6
11
2021
medline:
9
3
2022
entrez:
5
11
2021
Statut:
ppublish
Résumé
We aimed to identify the spectrum of disease in children with COVID-19, and the risk factors for admission in paediatric intensive care units (PICUs). We conducted a multicentre, prospective study of children with SARS-CoV-2 infection in 76 Spanish hospitals. We included children with COVID-19 or multi-inflammatory syndrome (MIS-C) younger than 18 years old, attended during the first year of the pandemic. We enrolled 1200 children. A total of 666 (55.5%) were hospitalised, and 123 (18.4%) required admission to PICU. Most frequent major clinical syndromes in the cohort were mild syndrome (including upper respiratory tract infection and flu-like syndrome, skin or mucosae problems and asymptomatic), 44.8%; bronchopulmonary syndrome (including pneumonia, bronchitis and asthma flare), 18.5%; fever without a source, 16.2%; MIS-C, 10.6%; and gastrointestinal syndrome, 10%. In hospitalised children, the proportions were 28.5%, 25.7%, 16.5%, 19.1% and 10.2%, respectively. Risk factors associated with PICU admission were age in months (OR: 1.007; 95% CI 1.004 to 1.01), MIS-C (OR: 14.4, 95% CI 8.9 to 23.8), chronic cardiac disease (OR: 4.8, 95% CI 1.8 to 13), asthma or recurrent wheezing (OR: 2.5, 95% CI 1.2 to 5.2) and after excluding MIS-C patients, moderate/severe liver disease (OR: 8.6, 95% CI 1.6 to 47.6). However, asthmatic children were admitted into the PICU due to MIS-C or pneumonia, not due to asthma flare.Conclusion: Hospitalised children with COVID-19 usually present as one of five major clinical phenotypes of decreasing severity. Risk factors for PICU include MIS-C, elevation of inflammation biomarkers, asthma, moderate or severe liver disease and cardiac disease. What is Known: • All studies suggest that children are less susceptible to serious SARS-CoV-2 infection when compared to adults. Most studies describe symptoms at presentation. However, it remains unclear how these symptoms group together into clinically identifiable syndromes and the severity associated with them. What is New: • We have gathered the primary diagnoses into five major syndromes of decreasing severity: MIS-C, bronchopulmonary syndrome, gastrointestinal syndrome, fever without a source and mild syndrome. Classification of the children in one of the syndromes is unique and helps to assess the risk of critical illness and to define the spectrum of the disease instead of just describing symptoms and signs.
Identifiants
pubmed: 34738173
doi: 10.1007/s00431-021-04306-6
pii: 10.1007/s00431-021-04306-6
pmc: PMC8568563
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1105-1115Subventions
Organisme : instituto de salud carlos iii
ID : PI20/00095
Organisme : instituto de salud carlos iii
ID : CM19/00015
Organisme : instituto de salud carlos iii
ID : CM20/00173
Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D (2020) Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis [Internet] 20(6):689–96. Available from: https://doi.org/10.1016/S1473-3099(20)30198-5
Instituto de Salud Carlos III (2020) Estudio ENE-COVID: cuarta ronda estudio nacional de sero-epidemiología de la infección por SARS-COV-2 en España. December 15th
Gudbjartsson DF, Helgason A, Jonsson H, Magnusson OT, Melsted P, Norddahl GL et al (2020) Spread of SARS-CoV-2 in the Icelandic population. N Engl J Med 382(24):2302–2315
doi: 10.1056/NEJMoa2006100
Lavezzo E, Franchin E, Ciavarella C, Cuomo-Dannenburg G, Barzon L, Del Vecchio C et al (2020) Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo’. Nature 584(August):425–429
doi: 10.1038/s41586-020-2488-1
Viner RM, Mytton OT, Bonell C, Melendez-Torres GJ, Ward J, Hudson L et al (2020) Susceptibility to SARS-CoV-2 infection among children and adolescents compared with adults: a systematic review and meta-analysis. JAMA Pediatr 1–14
Bi Q, Wu Y, Mei S, Ye C, Zou X, Zhang Z et al (2020) Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study. Lancet Infect Dis 20(8):911–919
doi: 10.1016/S1473-3099(20)30287-5
Dong Y, Dong Y, Mo X, Hu Y, Qi X, Jiang F et al (2020) Epidemiology of COVID-19 among children in China. Pediatr 145(6)
Fernandes DM, Oliveira CR, Guerguis S, Eisenberg R, Choi J, Kim M et al (2020) SARS-CoV-2 clinical phenotypes and predictors of disease severity in hospitalized children and youth. J Pediatr [Internet] Available from: http://www.ncbi.nlm.nih.gov/pubmed/33197493
Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P (2020) Hyperinflammatory shock in children during COVID-19 pandemic. Lancet [Internet] 395(10237):1607–1608. Available from: https://doi.org/10.1016/S0140-6736(20)31094-1
Manson JJ, Crooks C, Naja M, Ledlie A, Goulden B, Liddle T et al (2020) COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study. Lancet Rheumatol [Internet] 2(10):e594–602. Available from: https://doi.org/10.1016/S2665-9913(20)30275-7
World Health Organ (2020) Multisystem inflammatory syndrome in children and adolescents with COVID-19 1–3. Available from: https://www.who.int/publications/i/item/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19
Moraleda C, Serna-Pascual M, Soriano-Arandes A et al (2021) Multi-inflammatory syndrome in children related to SARS-CoV-2 in Spain. Clin Infect Dis 4;72(9):e397–e401. https://doi.org/10.1093/cid/ciaa1042
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform [Internet] 42(2):377–381. Available from: https://doi.org/10.1016/j.jbi.2008.08.010
ACLS Medical Training. Normal values in children. https://www.aclsmedicaltraining.com/normal-values-in-children/ Last Consulted, May 20th, 2021
Thiele C, Hirschfeld G (2020) Package cutpointr: improved estimation and validation of optimal cutpoints in R. Version 1.0.32. ; Available from: http://arxiv.org/abs/2002.09209
Villanuev RA, Chen ZJ, Wickham H (2016) ggplot2: elegant graphics for data analysis. In: Springer-Verlag New York
Goodrich B, Gabry J AI& BS (2020) rstanarm: Bayesian applied regression modeling via Stan. In: R package version 2211
Swann OV, Holden KA, Turtle L, Pollock L, Fairfield CJ, Drake TM et al (2020) Clinical characteristics of children and young people admitted to hospital with COVID-19 in United Kingdom: prospective multicentre observational cohort study. BMJ 370:1–15
Wang S, Fu L, Huang K, Han J, Zhang R, Fu Z (2020) Neutrophil-to-lymphocyte ratio on admission is an independent risk factor for the severity and mortality in patients with coronavirus disease 2019. J Infect
Giamarellos-Bourboulis EJ, Netea MG, Rovina N, Akinosoglou K, Antoniadou A, Antonakos N et al (2020) Complex immune dysregulation in COVID-19 patients with severe respiratory failure. Cell Host Microbe [Internet] 27(6):992–1000 e3. Available from: https://doi.org/10.1016/j.chom.2020.04.009
Kamrath C, Mönkemöller K, Biester T, Rohrer TR, Warncke K, Hammersen J, Holl RW (2020) Ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes during the COVID-19 pandemic in Germany. JAMA 324(8):801–804
Zachariah P, Johnson CL, Halabi KC, Ahn D, Sen AI, Fischer A et al (2020) Epidemiology, clinical features, and disease severity in patients with coronavirus disease 2019 (COVID-19) in a children’s hospital in New York City. New York JAMA Pediatr 174(10):1–7
Lishman J, Kohler C, de Vos C, van der Zalm MM, Itana J, Redfern A et al (2020) Acute appendicitis in multisystem inflammatory syndrome in children with COVID-19. Pediatr Infect Dis J Publish Ah(12):472–473
Stewart DJ, Hartley JC, Johnson M, Marks SD, du Pré P, Stojanovic J (2020) Renal dysfunction in hospitalised children with COVID-19. Lancet Child Adolesc Heal 4(8):e28–e29
doi: 10.1016/S2352-4642(20)30178-4
Vasconcelos MK, Epalza C, Renk H, Tagarro A, Bielicki JA (2020) Harmonisation preserves research resources. Lancet Infect Dis [Internet] 3099(20):30585. Available from: https://doi.org/10.1016/S1473-3099(20)30585-5
Price-Haywood EG, Burton J, Fort D, Seoane L (2020) Hospitalization and mortality among black patients and white patients with COVID-19. N Engl J Med 382(26):2534–2543
doi: 10.1056/NEJMsa2011686