Development and validation of a clinical predictive model for severe and critical pediatric COVID-19 infection

Abstract

Introduction Children infected with COVID-19 are susceptible to severe manifestations. We aimed to develop and validate a predictive model for severe/ critical pediatric COVID-19 infection utilizing routinely available hospital level data to ascertain the likelihood of developing severe manifestations. Methods The predictive model was based on an analysis of registry data from COVID-19 positive patients admitted to five tertiary pediatric hospitals across Asia [Singapore, Malaysia, Indonesia (two centers) and Pakistan]. Independent predictors of severe/critical COVID-19 infection were determined using multivariable logistic regression. A training cohort (n = 802, 70%) was used to develop the prediction model which was then validated in a test cohort (n = 345, 30%). The discriminative ability and performance of this model was assessed by calculating the Area Under the Curve (AUC) and 95% confidence interval (CI) from final Receiver Operating Characteristics Curve (ROC). Results A total of 1147 patients were included in this analysis. In the multivariable model, infant age group, presence of comorbidities, fever, vomiting, seizures and higher absolute neutrophil count were associated with an increased risk of developing severe/critical COVID-19 infection. The presence of coryza at presentation, higher hemoglobin and platelet count were associated with a decreased risk of severe/critical COVID-19 infection. The AUC (95%CI) generated for this model from the training and validation cohort were 0.96 (0.94, 0.98) and 0.92 (0.86, 0.97), respectively. Conclusion This predictive model using clinical history and commonly used laboratory values was valuable in estimating the risk of developing a severe/critical COVID-19 infection in hospitalized children. Further validation is needed to provide more insights into its utility in clinical practice.

COVID-19 as a polymorphic inflammatory spectrum of diseases: a review with focus on the brain

“…The relatively immature immunological apparatus and thus less tendency for uncontrolled or exaggerated inflammatory response such as cytokine storms (Palmeira et al ., 2020; Wong et al ., 2020; Yasuhara et al ., 2020) was originally claimed to be the explanation. This proves later to be a more complex situation, with an increase in paediatric COVID-19 patients suffering from multi-system inflammation with ominous outcomes (Dufort et al ., 2020; García-Salido et al ., 2020; Pereira et al ., 2020; Swann et al ., 2020; Wong et al ., 2022).…”

Hemoglobin and Its Relationship with Fatigue in Long-COVID Patients Three to Six Months after SARS-CoV-2 Infection

“…A decrease in hemoglobin may be one of the non-respiratory complications of a SARS-CoV-2 infection. In the acute phase of infection, a reduction in hemoglobin is likely mediated via interactions between viral agents and host cells and has previously been found to be a predictive factor for severe respiratory failure in pneumonic COVID-19 patients [ 11 , 12 ]. Based on the results of multivariate regression of a study comprising 1147 COVID-19 patients across five tertiary pediatric hospitals in Asia, higher levels of hemoglobin and platelets were protective against severe/critical COVID-19 infection [ 11 ].…”

“…In the acute phase of infection, a reduction in hemoglobin is likely mediated via interactions between viral agents and host cells and has previously been found to be a predictive factor for severe respiratory failure in pneumonic COVID-19 patients [ 11 , 12 ]. Based on the results of multivariate regression of a study comprising 1147 COVID-19 patients across five tertiary pediatric hospitals in Asia, higher levels of hemoglobin and platelets were protective against severe/critical COVID-19 infection [ 11 ]. A retrospective investigation of 23 COVID-19 hospitalized patients with pneumonia also revealed a significant association between higher levels of hemoglobin and a reduced need for mechanical ventilation administration, with an odds ratio of 0.313 [ 12 ].…”