tetano
Editor, Senior Moderator
Lancet Reg Health Am
. 2022 Aug;12:100272.
doi: 10.1016/j.lana.2022.100272. Epub 2022 May 17.
Paediatric critical COVID-19 and mortality in a multinational prospective cohort
Sebastian Gonzalez-Dambrauskas[SUP] 1 [/SUP], Pablo Vasquez-Hoyos[SUP] 2 [/SUP], Anna Camporesi[SUP] 3 [/SUP], Edwin Mauricio Cantillano[SUP] 4 [/SUP], Samantha Dallefeld[SUP] 5 [/SUP], Jesus Dominguez-Rojas[SUP] 6 [/SUP], Conall Francoeur[SUP] 7 [/SUP], Anar Gurbanov[SUP] 8 [/SUP], Liliana Mazzillo-Vega[SUP] 9 [/SUP], Steven L Shein[SUP] 10 [/SUP], Adriana Yock-Corrales[SUP] 11 [/SUP], Todd Karsies[SUP] 12 [/SUP], Critical Coronavirus and Kids Epidemiological (CAKE) Study Investigators
Affiliations
Abstract
Background: To understand critical paediatric coronavirus disease 2019 (COVID-19) and evaluate factors associated with mortality in children from high and low-middle income countries.
Methods: Prospective, observational study of critically ill children hospitalised for COVID-19 in 18 countries throughout North America, Latin America, and Europe between April 1 and December 31, 2020. Associations with mortality were evaluated using logistic regression.
Findings: 557 patients (median age, 8 years; 24% <2 years) were enrolled from 55 sites (63% Latin American). Half had comorbidities. Invasive (41%) or non-invasive (20%) ventilation and vasopressors (56%) were the most common support modalities. Hospital mortality was 10% and higher in children <2 years old (15%; odds ratio 1·94, 95%CI 1·08-3·49). Most who died had pulmonary disease. When adjusted for age, sex, region, and illness severity, mortality-associated factors included cardiac (aOR 2·89; 95%CI 1·2-6·94) or pulmonary comorbidities (aOR 4·43; 95%CI 1·70-11·5), admission hypoxemia (aOR 2·44; 95%CI 1·30-4·57), and lower respiratory symptoms (aOR 2·96; 95%CI 1·57-5·59). MIS-C (aOR 0·25; 95%CI 0·1-0·61) and receiving methylprednisolone (aOR 0·5; 95%CI 0·25-0·99), IVIG (aOR 0·32; 95%CI 0·16-0·62), or anticoagulation (aOR 0·49; 95%CI 0·25-0·95) were associated with lower mortality although these associations might be limited to children >2 years old.
Interpretation: We identified factors associated with COVID-19 mortality in critically ill children from both high and low-middle income countries, including higher mortality with younger age and COVID-related pulmonary disease but lower mortality in MIS-C. Further research is needed on optimal treatments for younger children and respiratory failure in paediatric COVID-19.
Funding: None.
Keywords: COVID-19; Epidemiology; Mortality; Outcomes; Paediatric intensive care unit.
. 2022 Aug;12:100272.
doi: 10.1016/j.lana.2022.100272. Epub 2022 May 17.
Paediatric critical COVID-19 and mortality in a multinational prospective cohort
Sebastian Gonzalez-Dambrauskas[SUP] 1 [/SUP], Pablo Vasquez-Hoyos[SUP] 2 [/SUP], Anna Camporesi[SUP] 3 [/SUP], Edwin Mauricio Cantillano[SUP] 4 [/SUP], Samantha Dallefeld[SUP] 5 [/SUP], Jesus Dominguez-Rojas[SUP] 6 [/SUP], Conall Francoeur[SUP] 7 [/SUP], Anar Gurbanov[SUP] 8 [/SUP], Liliana Mazzillo-Vega[SUP] 9 [/SUP], Steven L Shein[SUP] 10 [/SUP], Adriana Yock-Corrales[SUP] 11 [/SUP], Todd Karsies[SUP] 12 [/SUP], Critical Coronavirus and Kids Epidemiological (CAKE) Study Investigators
Affiliations
- PMID: 35599855
- PMCID: PMC9111167
- DOI: 10.1016/j.lana.2022.100272
Abstract
Background: To understand critical paediatric coronavirus disease 2019 (COVID-19) and evaluate factors associated with mortality in children from high and low-middle income countries.
Methods: Prospective, observational study of critically ill children hospitalised for COVID-19 in 18 countries throughout North America, Latin America, and Europe between April 1 and December 31, 2020. Associations with mortality were evaluated using logistic regression.
Findings: 557 patients (median age, 8 years; 24% <2 years) were enrolled from 55 sites (63% Latin American). Half had comorbidities. Invasive (41%) or non-invasive (20%) ventilation and vasopressors (56%) were the most common support modalities. Hospital mortality was 10% and higher in children <2 years old (15%; odds ratio 1·94, 95%CI 1·08-3·49). Most who died had pulmonary disease. When adjusted for age, sex, region, and illness severity, mortality-associated factors included cardiac (aOR 2·89; 95%CI 1·2-6·94) or pulmonary comorbidities (aOR 4·43; 95%CI 1·70-11·5), admission hypoxemia (aOR 2·44; 95%CI 1·30-4·57), and lower respiratory symptoms (aOR 2·96; 95%CI 1·57-5·59). MIS-C (aOR 0·25; 95%CI 0·1-0·61) and receiving methylprednisolone (aOR 0·5; 95%CI 0·25-0·99), IVIG (aOR 0·32; 95%CI 0·16-0·62), or anticoagulation (aOR 0·49; 95%CI 0·25-0·95) were associated with lower mortality although these associations might be limited to children >2 years old.
Interpretation: We identified factors associated with COVID-19 mortality in critically ill children from both high and low-middle income countries, including higher mortality with younger age and COVID-related pulmonary disease but lower mortality in MIS-C. Further research is needed on optimal treatments for younger children and respiratory failure in paediatric COVID-19.
Funding: None.
Keywords: COVID-19; Epidemiology; Mortality; Outcomes; Paediatric intensive care unit.