Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children
Objective To identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection.Design Multicentre retrospective cohort study.Setting 18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May 2021.Patients Children<18 years of age hospitalised for symp...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-08-01
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| Series: | BMJ Paediatrics Open |
| Online Access: | https://bmjpaedsopen.bmj.com/content/6/1/e001440.full |
| _version_ | 1811315597829472256 |
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| author | Jesse Papenburg Dara Petel Joan L Robinson Shaun K Morris Manish Sadarangani Karina A Top Ann Bayliss Tammie Dewan Ali Manafi Ashley Roberts Ari Bitnun Rosie Scuccimarri Helena Brenes-Chacon Alejandra Soriano-Fallas Rolando Ulloa-Gutierrez Jacqueline Wong Peter Gill Michelle Barton Jared Bullard Adriana Yock-Corrales Fatima Kakkar Tilmann Schober Chelsea Caya Jennifer Bowes Suzette Cooke Rachel Dwilow Tala El Tal Cheryl Foo Behzad Haghighi Aski Janell Lautermilch Marie-Astrid Lefebvre Kirk Leifso Nicole Le Saux Alison Lopez Joanna Merckx Alireza Nateghian Luc Panetta Dominique Piché Rupeena Purewal Lea Restivo Sarah Tehseen Isabelle Viel-Theriault Carmen Yea Ann Yeh |
| author_facet | Jesse Papenburg Dara Petel Joan L Robinson Shaun K Morris Manish Sadarangani Karina A Top Ann Bayliss Tammie Dewan Ali Manafi Ashley Roberts Ari Bitnun Rosie Scuccimarri Helena Brenes-Chacon Alejandra Soriano-Fallas Rolando Ulloa-Gutierrez Jacqueline Wong Peter Gill Michelle Barton Jared Bullard Adriana Yock-Corrales Fatima Kakkar Tilmann Schober Chelsea Caya Jennifer Bowes Suzette Cooke Rachel Dwilow Tala El Tal Cheryl Foo Behzad Haghighi Aski Janell Lautermilch Marie-Astrid Lefebvre Kirk Leifso Nicole Le Saux Alison Lopez Joanna Merckx Alireza Nateghian Luc Panetta Dominique Piché Rupeena Purewal Lea Restivo Sarah Tehseen Isabelle Viel-Theriault Carmen Yea Ann Yeh |
| author_sort | Jesse Papenburg |
| collection | DOAJ |
| description | Objective To identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection.Design Multicentre retrospective cohort study.Setting 18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May 2021.Patients Children<18 years of age hospitalised for symptomatic PCR-positive SARS-CoV-2 infection, including PCR-positive multisystem inflammatory syndrome in children (MIS-C).Main outcome measure Severity on the WHO COVID-19 Clinical Progression Scale was used for ordinal logistic regression analyses.Results We identified 403 hospitalisations. Median age was 3.78 years (IQR 0.53–10.77). At least one comorbidity was present in 46.4% (187/403) and multiple comorbidities in 18.6% (75/403). Eighty-one children (20.1%) met WHO criteria for PCR-positive MIS-C. Progression to WHO clinical scale score ≥6 occurred in 25.3% (102/403). In multivariable ordinal logistic regression analyses adjusted for age, chest imaging findings, laboratory-confirmed bacterial and/or viral coinfection, and MIS-C diagnosis, presence of a single (adjusted OR (aOR) 1.90, 95% CI 1.13 to 3.20) or multiple chronic comorbidities (aOR 2.12, 95% CI 1.19 to 3.79), obesity (aOR 3.42, 95% CI 1.76 to 6.66) and chromosomal disorders (aOR 4.47, 95% CI 1.25 to 16.01) were independent risk factors for severity. Age was not an independent risk factor, but different age-specific comorbidities were associated with more severe disease in age-stratified adjusted analyses: cardiac (aOR 2.90, 95% CI 1.11 to 7.56) and non-asthma pulmonary disorders (aOR 3.07, 95% CI 1.26 to 7.49) in children<12 years old and obesity (aOR 3.69, 1.45–9.40) in adolescents≥12 years old. Among infants<1 year old, neurological (aOR 10.72, 95% CI 1.01 to 113.35) and cardiac disorders (aOR 10.13, 95% CI 1.69 to 60.54) were independent predictors of severe disease.Conclusion We identified risk factors for disease severity among children hospitalised for PCR-positive SARS-CoV-2 infection. Comorbidities predisposing children to more severe disease may vary by age. These findings can potentially guide vaccination programmes and treatment approaches in children. |
| first_indexed | 2024-04-13T11:33:13Z |
| format | Article |
| id | doaj.art-91a37f70257043ebbf22a216fa81f44a |
| institution | Directory Open Access Journal |
| issn | 2399-9772 |
| language | English |
| last_indexed | 2024-04-13T11:33:13Z |
| publishDate | 2022-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Paediatrics Open |
| spelling | doaj.art-91a37f70257043ebbf22a216fa81f44a2022-12-22T02:48:31ZengBMJ Publishing GroupBMJ Paediatrics Open2399-97722022-08-016110.1136/bmjpo-2022-001440Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised childrenJesse Papenburg0Dara Petel1Joan L Robinson2Shaun K Morris3Manish Sadarangani4Karina A Top5Ann Bayliss6Tammie Dewan7Ali Manafi8Ashley Roberts9Ari Bitnun10Rosie Scuccimarri11Helena Brenes-Chacon12Alejandra Soriano-Fallas13Rolando Ulloa-Gutierrez14Jacqueline Wong15Peter Gill16Michelle Barton17Jared Bullard18Adriana Yock-Corrales19Fatima Kakkar20Tilmann Schober21Chelsea Caya22Jennifer Bowes23Suzette Cooke24Rachel Dwilow25Tala El Tal26Cheryl Foo27Behzad Haghighi Aski28Janell Lautermilch29Marie-Astrid Lefebvre30Kirk Leifso31Nicole Le Saux32Alison Lopez33Joanna Merckx34Alireza Nateghian35Luc Panetta36Dominique Piché37Rupeena Purewal38Lea Restivo39Sarah Tehseen40Isabelle Viel-Theriault41Carmen Yea42Ann Yeh43McGill University Health Centre, Montreal, Quebec, Canada1 Department of Pediatrics, University of Western Ontario, London, Ontario, CanadaDepartment of Pediatrics, University of Alberta, Edmonton, Alberta, CanadaCentre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, CanadaVaccine Evaluation Center, BC Children`s Hospital Research Institute, Vancouver, British Columbia, CanadaCanadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia, CanadaTrillium Health Partners, University of Toronto, Mississauga, Ontario, CanadaDepartment of Paediatrics, The University of British Columbia, Vancouver, British Columbia, Canada44 Plastic Surgery Department, Iran University of Medical Sciences, Tehran, IranDepartment of Pediatrics, University of British Columbia, Vancouver, British Columbia, CanadaDivision of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada9McGill University Health Centre and McGill University, Montréal, Québec, CanadaUniversidad de Ciencias Medicas (UCIMED), San Jose, Costa RicaUniversidad de Ciencias Medicas (UCIMED), San Jose, Costa RicaUniversidad de Ciencias Medicas (UCIMED), San Jose, Costa RicaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKDivision of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada2 Manitoba Health, Healthy Living, and Seniors, Winnipeg, Manitoba, Canada5 Emergency Department, Hospital Nacional de Ninos, San Jose, Costa RicaPediatric Infectious Diseases, CHU Sainte-Justine, Montreal, Quebec, CanadaDepartment of Pediatrics, McGill University, Montreal, Quebec, CanadaResearch Institute of the McGill University Health Centre, Montreal, Quebec, CanadaDepartment of Pediatrics, University of Ottawa, Ottawa, Ontario, CanadaDepartment of Pediatrics, University of Calgary, Calgary, Alberta, CanadaDepartment of Pediatrics, University of Manitoba, Winnipeg, Manitoba, CanadaDepartment of Pediatrics, University of Toronto, Toronto, Ontario, CanadaDepartment of Pediatrics, Memorial University of Newfoundland, St. John`s, Newfoundland and Labrador, CanadaDepartment of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaDepartment of Pediatrics, McGill University, Montreal, Quebec, CanadaDepartment of Pediatrics, Queen`s University, Kingston, Ontario, CanadaDepartment of Pediatrics, University of Ottawa, Ottawa, Ontario, CanadaBritish Columbia Children`s Hospital, Vancouver, British Columbia, CanadaDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, CanadaDepartment of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)Department of Pediatrics, Universite de Montreal, Montreal, Quebec, CanadaDepartment of Pediatrics, Dalhousie University, Halifax, British Columbia, CanadaDepartment of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaDepartment of Pediatrics, University of Calgary, Calgary, Alberta, CanadaDepartment of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaDepartment of Pediatrics, CHU de Québec-Université Laval, Quebec, CanadaDepartment of Pediatrics, University of Toronto, Toronto, Ontario, CanadaDepartment of Pediatrics, University of Toronto, Toronto, Ontario, CanadaObjective To identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection.Design Multicentre retrospective cohort study.Setting 18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May 2021.Patients Children<18 years of age hospitalised for symptomatic PCR-positive SARS-CoV-2 infection, including PCR-positive multisystem inflammatory syndrome in children (MIS-C).Main outcome measure Severity on the WHO COVID-19 Clinical Progression Scale was used for ordinal logistic regression analyses.Results We identified 403 hospitalisations. Median age was 3.78 years (IQR 0.53–10.77). At least one comorbidity was present in 46.4% (187/403) and multiple comorbidities in 18.6% (75/403). Eighty-one children (20.1%) met WHO criteria for PCR-positive MIS-C. Progression to WHO clinical scale score ≥6 occurred in 25.3% (102/403). In multivariable ordinal logistic regression analyses adjusted for age, chest imaging findings, laboratory-confirmed bacterial and/or viral coinfection, and MIS-C diagnosis, presence of a single (adjusted OR (aOR) 1.90, 95% CI 1.13 to 3.20) or multiple chronic comorbidities (aOR 2.12, 95% CI 1.19 to 3.79), obesity (aOR 3.42, 95% CI 1.76 to 6.66) and chromosomal disorders (aOR 4.47, 95% CI 1.25 to 16.01) were independent risk factors for severity. Age was not an independent risk factor, but different age-specific comorbidities were associated with more severe disease in age-stratified adjusted analyses: cardiac (aOR 2.90, 95% CI 1.11 to 7.56) and non-asthma pulmonary disorders (aOR 3.07, 95% CI 1.26 to 7.49) in children<12 years old and obesity (aOR 3.69, 1.45–9.40) in adolescents≥12 years old. Among infants<1 year old, neurological (aOR 10.72, 95% CI 1.01 to 113.35) and cardiac disorders (aOR 10.13, 95% CI 1.69 to 60.54) were independent predictors of severe disease.Conclusion We identified risk factors for disease severity among children hospitalised for PCR-positive SARS-CoV-2 infection. Comorbidities predisposing children to more severe disease may vary by age. These findings can potentially guide vaccination programmes and treatment approaches in children.https://bmjpaedsopen.bmj.com/content/6/1/e001440.full |
| spellingShingle | Jesse Papenburg Dara Petel Joan L Robinson Shaun K Morris Manish Sadarangani Karina A Top Ann Bayliss Tammie Dewan Ali Manafi Ashley Roberts Ari Bitnun Rosie Scuccimarri Helena Brenes-Chacon Alejandra Soriano-Fallas Rolando Ulloa-Gutierrez Jacqueline Wong Peter Gill Michelle Barton Jared Bullard Adriana Yock-Corrales Fatima Kakkar Tilmann Schober Chelsea Caya Jennifer Bowes Suzette Cooke Rachel Dwilow Tala El Tal Cheryl Foo Behzad Haghighi Aski Janell Lautermilch Marie-Astrid Lefebvre Kirk Leifso Nicole Le Saux Alison Lopez Joanna Merckx Alireza Nateghian Luc Panetta Dominique Piché Rupeena Purewal Lea Restivo Sarah Tehseen Isabelle Viel-Theriault Carmen Yea Ann Yeh Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children BMJ Paediatrics Open |
| title | Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children |
| title_full | Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children |
| title_fullStr | Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children |
| title_full_unstemmed | Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children |
| title_short | Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children |
| title_sort | risk factors for severe pcr positive sars cov 2 infection in hospitalised children |
| url | https://bmjpaedsopen.bmj.com/content/6/1/e001440.full |
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