Risk factors for poor prognosis in children and adolescents with COVID-19: A systematic review and meta-analysis

Abstract

Background This study provides the first systematic review and meta-analysis to identify the predictors of unfavorable prognosis of COVID-19 in children and adolescents. Methods We searched literature databases until July 2021 for studies that investigated risk factors for unfavorable prognosis of children and adolescents with COVID-19. We used random-effects models to estimate the effect size with 95% confidence interval ( CI ). Findings We identified 56 studies comprising 79,104 individuals. Mortality was higher in patients with multisystem inflammatory syndrome (MIS-C) (odds ratio [ OR ]=58.00, 95% CI 6.39–526.79) and who were admitted to intensive care ( OR =12.64, 95% CI 3.42–46.68). Acute respiratry distress syndrme (ARDS) ( OR =29.54, 95% CI 12.69–68.78) and acute kidney injury (AKI) ( OR =55.02, 95% CI 6.26–483.35) increased the odds to be admitted to intensive care; shortness of breath ( OR =16.96, 95% CI 7.66–37.51) increased the need of respiratory support; and neurological diseases ( OR =5.16, 95% CI 2.30–11.60), C-reactive protein (CRP) level ≥80 mg/L ( OR =11.70, 95% CI 4.37–31.37) and D-dimer level ≥0.5ug/mL ( OR =20.40, 95% CI 1.76–236.44) increased the odds of progression to severe or critical disease. Interpretation Congenital heart disease, chronic pulmonary disease, neurological diseases, obesity, MIS-C, shortness of breath, ARDS, AKI, gastrointestinal symptoms, elevated CRP and D-dimer are associated with unfavourable prognosis in children and adolescents with COVID-19.

COVID-19 trends and severity among symptomatic children aged 0–17 years in 10 European Union countries, 3 August 2020 to 3 October 2021

“…This study highlights that the risk of a severe COVID-19 outcome is substantially elevated for children with underlying risk factors compared with healthy children [ 8 ]. However, among paediatric COVID-19 cases with information on comorbidities, 83.7% had no reported comorbidity, demonstrating a potential population-level impact of high levels of community transmission leading to large numbers of hospital admissions among healthy children.…”

CXCL10/IP10 as a Biomarker Linking Multisystem Inflammatory Syndrome and Left Ventricular Dysfunction in Children with SARS-CoV-2

“…However, the disease course is quite different in children. Instead of displaying direct respiratory effects of the virus, severe pediatric cases tend to present with a hyperinflammatory response that is now called MIS-C. A recent meta-analysis investigating the predictive factors for poor prognosis in 79,104 pediatric patients with COVID-19 confirmed that patients with MIS-C had an increased risk for mortality (odds ratio (OR) = 58.00, 95% CI 6.39–526.79) [ 11 ]. Although initial studies reported MIS-C as a Kawasaki-like disease, it is now accepted that MIS-C may present with different phenotypes and outcomes [ 3 , 12 , 13 ].…”

“Vaccinate every child against COVID-19”

“…Like adults, risk factors including type 2 diabetes, asthma, heart and pulmonary diseases, neurologic, neurodevelopmental (in particular, Down Syndrome) and neuromuscular conditions, and obesity have been found to affect the severity of the disease among children. [ 27 ]…”