TY - JOUR
T1 - Severe Acute Respiratory Syndrome Coronavirus 2 Clinical Syndromes and Predictors of Disease Severity in Hospitalized Children and Youth
AU - The Tri-State Pediatric COVID-19 Research Consortium
AU - Fernandes, Danielle M.
AU - Oliveira, Carlos R.
AU - Guerguis, Sandra
AU - Eisenberg, Ruth
AU - Choi, Jaeun
AU - Kim, Mimi
AU - Abdelhemid, Ashraf
AU - Agha, Rabia
AU - Agarwal, Saranga
AU - Aschner, Judy L.
AU - Avner, Jeffrey R.
AU - Ballance, Cathleen
AU - Bock, Joshua
AU - Bhavsar, Sejal M.
AU - Campbell, Melissa
AU - Clouser, Katharine N.
AU - Gesner, Matthew
AU - Goldman, David L.
AU - Hammerschlag, Margaret R.
AU - Hymes, Saul
AU - Howard, Ashley
AU - Jung, Hee jin
AU - Kohlhoff, Stephan
AU - Kojaoghlanian, Tsoline
AU - Lewis, Rachel
AU - Nachman, Sharon
AU - Naganathan, Srividya
AU - Paintsil, Elijah
AU - Pall, Harpreet
AU - Sy, Sharlene
AU - Wadowski, Stephen
AU - Zirinsky, Elissa
AU - Cabana, Michael D.
AU - Herold, Betsy C.
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/3
Y1 - 2021/3
N2 - Objective: To characterize the demographic and clinical features of pediatric severe acute respiratory syndrome coronavirus 2 (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 8 sites in New York, New Jersey, and Connecticut. Results: We identified 281 hospitalized patients with SARS-CoV-2 infections and divided them into 3 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% vs 18%, P = .02). Seven patients (2%) died and 114 (41%) were admitted to the intensive care unit. 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 109 cells/L, 95% CI 2.32-33.33, P = .001) and greater 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.
AB - Objective: To characterize the demographic and clinical features of pediatric severe acute respiratory syndrome coronavirus 2 (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 8 sites in New York, New Jersey, and Connecticut. Results: We identified 281 hospitalized patients with SARS-CoV-2 infections and divided them into 3 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% vs 18%, P = .02). Seven patients (2%) died and 114 (41%) were admitted to the intensive care unit. 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 109 cells/L, 95% CI 2.32-33.33, P = .001) and greater 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.
KW - COVID-19
KW - biomarkers
UR - http://www.scopus.com/inward/record.url?scp=85097772508&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85097772508&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2020.11.016
DO - 10.1016/j.jpeds.2020.11.016
M3 - Article
C2 - 33197493
AN - SCOPUS:85097772508
SN - 0022-3476
VL - 230
SP - 23-31.e10
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -