Severe Acute Respiratory Syndrome Coronavirus 2 Clinical Syndromes and Predictors of Disease Severity in Hospitalized Children and Youth

Abstract

Objective To characterize the demographic and clinical features of pediatric SARS-CoV-2 syndromes and identify admission variables predictive of disease severity. Study design We conducted a multicenter, retrospective and prospective study of pediatric patients hospitalized with acute SARS-CoV-2 infections and multisystem inflammatory syndrome in children (MIS-C) at eight sites in New York, New Jersey, and Connecticut. Results We identified 281 hospitalized patients with SARS-CoV-2 infections and divided them into three groups based on clinical features. Overall, 143 (51%) had respiratory disease, 69 (25%) had MIS-C, and 69 (25%) had other manifestations including gastrointestinal illness or fever. Patients with MIS-C were more likely to identify as non-Hispanic black compared with patients with respiratory disease (35% versus 18%, P =.02). Seven patients (2%) died and 114 (41%) were admitted to the ICU. In multivariable analyses, obesity (OR=3.39, 95% CI:1.26-9.10, P =.02) and hypoxia on admission (OR=4.01; 95% CI:1.14-14.15; P =.03) were predictive of severe respiratory disease. Lower absolute lymphocyte count (OR=8.33 per unit decrease in 10 9 cells/L, 95% CI:2.32-33.33, P =.001) and higher C-reactive protein (OR=1.06 per unit increase in mg/dL, 95% CI:1.01-1.12, P =.017) were predictive of severe MIS-C. Race/ethnicity or socioeconomic status were not predictive of disease severity. Conclusions We identified variables at the time of hospitalization that may help predict the development of severe SARS-CoV-2 disease manifestations in children and youth. These variables may have implications for future prognostic tools that inform hospital admission and clinical management.

Factors Associated With Severe SARS-CoV-2 Infection

“…32 Elevated levels of inflammatory parameters and respiratory symptoms were also found as a prognostic factor. 34 This surveillance system allowed us to identify different clinical profiles of hospitalized children with SARS-CoV-2 infections, ranging from pauci-symptomatic forms to MIS-C. The main clinical symptoms reported in our cohort agreed with the literature (fever in 70-80%, cough 40-50%, dyspnea 30-40%).…”

Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning

“…Shared pathophysiology underlying greater COVID-19 susceptibility in people with T2D or obesity may include heightened basal inflammatory tone, defective adaptive immune responses, endothelial dysfunction, and a greater propensity for development of coagulation-related complications ( Figure 1 ). Collectively, the available data suggest that the relationship between increasing BMI, severity of SARS-CoV-2 infection, and outcomes is not always linear; more relevant in younger people ( Burn et al., 2020 ), including children ( Duarte-Salles et al., 2020 ; Fernandes et al., 2020 ; Tsankov et al., 2020 ); and frequently complicated in adults by co-existing cardiometabolic risk factors. A diagnosis of T2D is also associated with adverse COVID-19 outcomes in younger adults, even those between 20 and 39 years of age ( Woolcott and Castilla-Bancayán, 2020 ).…”

Multicenter cohort study of children hospitalized with SARS-CoV-2 infection

“…The incidence and burden of asymptomatic and mild infections in hospitalized children is just beginning to be described; 34 of 315 infected youth and young adults (11%) admitted to 8 United States (US) hospitals in April 2020 had “incidental” SARS-CoV-2 infection [16]. SARS-CoV-2 was not suspected at the time of admission in approximately half of the children in the current study.…”

“…Of 363 children admitted to 82 health care institutions in Europe in April 2020, 75 (21%) required supplemental oxygen, including 48 (13%) who required ICU admission; 25 (7%) were managed with mechanical ventilation and 4 (1.1%) died [15]. Of 281 patients up to 22 years of age admitted to 8 US hospitals up to April 12, 2020, 70 of 212 (33%) with COVID-19 were admitted to ICU, 26 (12%) required mechanical ventilation and 7 (3%) died while 44 of 69 (64%) with MIS-C were admitted to ICU, 3 (4%) required mechanical ventilation and none died [16].…”

“…In the previously mentioned European study, risk factors for ICU admission with either COVID-19 or MIS-C included age younger than 1-month, male sex, comorbidities, and presence of lower respiratory tract infection signs or symptoms at presentation (not further defined) [15]. In the previously mentioned study from the US, risk factors for ICU admission for 48 hours of more for COVID-19 included younger age, obesity, hypoxia, higher admission white blood cell count and bilateral infiltrates on admission chest radiograph [16]; risk factors for ICU admission for MIS-C were not reported. A previous pediatric systematic review also reported obesity as a risk factor for severe disease [19] while it did not appear to be a risk factor in the current study.…”