Characteristics and risk factors associated with critical illness in pediatric COVID-19

Abstract

Background While much has been reported regarding the clinical course of COVID-19 in children, little is known regarding factors associated with organ dysfunction in pediatric COVID-19. We describe critical illness in pediatric patients with active COVID-19 and identify factors associated with PICU admission and organ dysfunction. This is a retrospective chart review of 77 pediatric patients age 1 day to 21 years admitted to two New York City pediatric hospitals within the Northwell Health system between February 1 and April 24, 2020 with PCR + SARS-CoV-2. Descriptive statistics were used to describe the hospital course and laboratory results and bivariate comparisons were performed on variables to determine differences. Results Forty-seven patients (61%) were admitted to the general pediatric floor and thirty (39%) to the PICU. The majority (97%, n = 75) survived to discharge, 1.3% (n = 1) remain admitted, and 1.3% (n = 1) died. Common indications for PICU admission included hypoxia (50%), hemodynamic instability (20%), diabetic ketoacidosis (6.7%), mediastinal mass (6.7%), apnea (6.7%), acute chest syndrome in sickle cell disease (6.7%), and cardiac dysfunction (6.7%). Of PICU patients, 46.7% experienced any significant organ dysfunction (pSOFA > = 2) during admission. Patients aged 12 years or greater were more likely to be admitted to a PICU compared to younger patients (p = 0.015). Presence of an underlying comorbidity was not associated with need for PICU admission (p = 0.227) or organ dysfunction (p = 0.87). Initial white blood cell count (WBC), platelet count, and ferritin were not associated with need for PICU admission. Initial C-reactive protein was associated with both need for PICU admission (p = 0.005) and presence of organ dysfunction (p = 0.001). Initial WBC and presenting thrombocytopenia were associated with organ dysfunction (p = 0.034 and p = 0.003, respectively). Conclusions Age over 12 years and initial CRP were associated with need for PICU admission in COVID-19. Organ dysfunction was associated with elevated admission CRP, elevated WBC, and thrombocytopenia. These factors may be useful in determining risk for critical illness and organ dysfunction in pediatric COVID-19.

COVID-19 in Pediatrics

“… 4 Being older than 12 years and having a high initial C-reactive protein (CRP) are risk factors for admission to a pediatric intensive care unit (PICU), and high CRP, leukocytosis, and thrombocytopenia are risk factors for organ dysfunction. 5 Viral load and young age, specifically children under 1 year of age, are other risk factors for more severe disease. 6 …”

“… 12 Patients with chronic conditions may have a concomitant worsening of their underlying disease, including diabetic ketoacidosis and acute chest syndrome. 5 …”

“… 40 Median initial CRP is higher amongst patients requiring pediatric intensive care unit admission, and in those who develop organ dysfunction. 5 Lymphopenia is common (58%), while around 20% have neutrophilia, anemia, or thrombocytopenia. 40 Higher median initial white blood cell count and lower median initial platelet count were seen in patients who develop organ dysfunction.…”

“… 40 Higher median initial white blood cell count and lower median initial platelet count were seen in patients who develop organ dysfunction. 5 As for cardiac markers, around 40% have elevated BNP, and over 30% have high troponin. 40 High BNP and troponin, and low platelets and lymphocytes are associated with need for intensive care.…”

Çocuklarda COVİD-19 ve Yoğun Bakım Yönetimi

“…Pediatrik COVID-19'da kritik hastalık ve organ disfonksiyonu riskini belirlemede yararlı faktörler olarak; eşlik eden komorbit bir hastalık, 12 yaş üzeri olma, yüksek CRP değeri, yüksek WBC ve trombositopeni bildirilmiştir 9 . Çalışmalarda COVID-19' lu çocuklarda mekanik ventilasyon ihtiyacı, yüksek CRP ile ilişkilendirilmiştir 10 .…”