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BMC Infect Dis
. 2025 Nov 18;25(1):1611.
doi: 10.1186/s12879-025-12024-9. Risk factors for severe disease in children hospitalized with SARS-CoV-2 infection in China: a retrospective cohort study
Yan Wang # 1 , Ye Song # 1 2 , Binhui Zhu 1 , You Feng 1 , Dandan Lou 3 , Yueping Zhang 4
Affiliations
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread rapidly worldwide since its emergence in 2019. While infections in children are generally mild, severe disease can occur in some rare cases. Herein, we aim to identify risk factors for severe disease in children hospitalized with SARS-CoV-2 infection during the post-Omicron period.
Methods: This retrospective cohort study was based on a review of the records of children aged under 15 years hospitalized with SARS-CoV-2 infection at a university hospital in Xi'an, China between December 8, 2022, and January 17, 2023. Multivariable logistic regression was applied to identify factors associated with severe disease.
Results: Of 164 children included in the analysis, 33 had severe disease and 131 had non-severe disease. Disease severity did not differ significantly according to sex or SARS-CoV-2 vaccination status. The prevalence of comorbidities was significantly higher in children with severe disease than in those with non-severe disease (30% [10/33] vs. 10.7% [14/131], p = 0.04). The prevalence of neurological manifestations and multisystem disease were also significantly higher in children with severe disease than in those with non-severe disease (91% [30/33] vs. 27.5% [36/131], p = 0.001; and 64% [21/33] vs. 43.5% [57/131], p = 0.039, respectively). Multivariable logistic regression analysis identified younger age (odds ratio [OR]: 0.702, 95% confidence interval [CI]: 0.551-0.893; p = 0.004), the presence of comorbidities (OR: 9.042, 95% CI: 2.505X-32.645; p = 0.001), and neurological signs (OR: 217.21, 95% CI: 34.988-1348.469; p < 0.001) as independent risk factors for severe disease.
Conclusion: This single-center retrospective cohort study reveals that younger children with comorbidities and neurological manifestations are at higher risk of developing severe SARS-CoV-2 infection. These findings should be interpreted considering limitations including short study timeframe, homogeneous vaccine types, and lack of variant-specific analyses.
Keywords: COVID-19; Comorbidities; Neurological signs; SARS-CoV-2 vaccination.
. 2025 Nov 18;25(1):1611.
doi: 10.1186/s12879-025-12024-9. Risk factors for severe disease in children hospitalized with SARS-CoV-2 infection in China: a retrospective cohort study
Yan Wang # 1 , Ye Song # 1 2 , Binhui Zhu 1 , You Feng 1 , Dandan Lou 3 , Yueping Zhang 4
Affiliations
- PMID: 41254536
- DOI: 10.1186/s12879-025-12024-9
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread rapidly worldwide since its emergence in 2019. While infections in children are generally mild, severe disease can occur in some rare cases. Herein, we aim to identify risk factors for severe disease in children hospitalized with SARS-CoV-2 infection during the post-Omicron period.
Methods: This retrospective cohort study was based on a review of the records of children aged under 15 years hospitalized with SARS-CoV-2 infection at a university hospital in Xi'an, China between December 8, 2022, and January 17, 2023. Multivariable logistic regression was applied to identify factors associated with severe disease.
Results: Of 164 children included in the analysis, 33 had severe disease and 131 had non-severe disease. Disease severity did not differ significantly according to sex or SARS-CoV-2 vaccination status. The prevalence of comorbidities was significantly higher in children with severe disease than in those with non-severe disease (30% [10/33] vs. 10.7% [14/131], p = 0.04). The prevalence of neurological manifestations and multisystem disease were also significantly higher in children with severe disease than in those with non-severe disease (91% [30/33] vs. 27.5% [36/131], p = 0.001; and 64% [21/33] vs. 43.5% [57/131], p = 0.039, respectively). Multivariable logistic regression analysis identified younger age (odds ratio [OR]: 0.702, 95% confidence interval [CI]: 0.551-0.893; p = 0.004), the presence of comorbidities (OR: 9.042, 95% CI: 2.505X-32.645; p = 0.001), and neurological signs (OR: 217.21, 95% CI: 34.988-1348.469; p < 0.001) as independent risk factors for severe disease.
Conclusion: This single-center retrospective cohort study reveals that younger children with comorbidities and neurological manifestations are at higher risk of developing severe SARS-CoV-2 infection. These findings should be interpreted considering limitations including short study timeframe, homogeneous vaccine types, and lack of variant-specific analyses.
Keywords: COVID-19; Comorbidities; Neurological signs; SARS-CoV-2 vaccination.