Profile, risk factors for severe disease and predictors of mortality in children with COVID-19: experience from a tertiary COVID-care center in India

Authors

  • Puneet Kaur Sahi Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
  • Pallavi Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
  • Romit Saxena Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
  • Urmila Jhamb Department of Pediatrics, Maulana Azad Medical College, New Delhi, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20233239

Keywords:

Risk factors, Predictors, Pediatrics, COVID-19, Severity

Abstract

Background: Knowledge of pediatric COVID-19 is important to determine those at risk for severe disease and mortality. There is limited data on risk factors for development of severe disease and predictors of mortality amongst children with COVID-19, especially from the developing nations. We aimed to study the profile, risk factors for severe COVID-19 and predictors of mortality in children with laboratory confirmed COVID-19.

Methods: This prospective observational study was conducted from April to September 2020 in the Department of Pediatrics of a referral COVID-care hospital in Northern-India. All children 1 month to 18 years of age, hospitalized in the Pediatrics Department and having a positive Reverse Transcriptase-Polymerase chain reaction (RT-PCR) for SARS-CoV-2 infection on their combined oro-nasopharyngeal swab were enrolled.

Results: A total of 335 SARS-CoV-2 positive children were enrolled with median age of 6 years, slight male predominance (54%) and 24.4% infants. Commonest presentations were respiratory (47.7%), gastrointestinal (33.3%) and neurological (14.9%) with moderate/severe disease in 24%, mortality in 4.8%, co-morbidities in 20.5% and co-infections in 17.9%. Risk factors for severe disease were underlying co-infection (p=0.017), associated tuberculosis (p=0.0015), associated culture positive bacterial sepsis (p=<0.001) and being underweight (p<0.001). Overweight/obese children had less severe COVID-19 (p=0.0016). Predictors of mortality were co-infections (p=0.0019), hypoxia (p<0.001), neurological manifestations (p=0.016), acute respiratory distress syndrome (p<0.001), acute kidney injury (p=0.05), shock (p<0.001), thrombocytopenia (p=0.021), leucopenia (p=0.028), lymphopenia (p=0.021), high Neutrophil:Lymphocyte ratio (p=0.02), coagulopathy (p=0.02), azotemia (p=0.038) and raised creatinine (p=0.05).

Conclusions: Children with identified risk factors for severe disease and mortality should receive prioritized treatment.

 

References

Meena J, Yadav J, Saini L. Clinical Features and Outcome of SARS-CoV-2 Infection in Children: A Systematic Review and Meta-analysis. Indian Pediatr. 2020;57(9):820-6.

Garazzino S, Montagnani C, Donà D. Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April. Euro Surveill. 2020;25(18):200.

Feng K, Yun YX, Wang XF. Analysis of CT features of 15children with 2019 novel coronavirus infection. Chinese J Pediatr. 2020;58:275-8.

Götzinger F, Santiago-García B, Noguera-Julián A. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health. 2020;4(9):653-61.

Sharma AG, Kumar V, Sodani R. Predictors of mortality in children admitted with SARS-CoV-2 infection to a tertiary care hospital in North India. J Paediatr Child Health. 2022;58(3):432-9.

Efendi F, Haryanto J, Has EMM. Predictors of Mortality Among Children with Confirmed and Suspected Cases of COVID-19 in East Java, Indonesia. J Multidiscip Healthc. 2023;16:355-62.

Singh P, Attri K, Mahto D. Clinical Profile of COVID-19 Illness in Children-Experience from a Tertiary Care Hospital. Indian J Pediatr. 2022;89(1):45-51.

Jat KR, Sankar J, Das RR, et al. Clinical Profile and Risk Factors for Severe Disease in 402 Children Hospitalized with SARS-CoV-2 from India: Collaborative Indian Pediatric COVID Study Group. J Trop Pediatr. 2021;67(3):48.

Ramteke S, Tikkas R, Goel M. Paediatric COVID-19: Milder Presentation-A Silver Lining in Dark Cloud. J Trop Pediatr. 2021;67(1):106.

Turuk A, Kumar G, Mukherjee A, et al. Evaluation of a Hospitalized Pediatric COVID-19 Cohort from Indian National Clinical Registry of COVID-19. Indian J Pediatr. 2023;1-8.

Harwood R, Yan H, Talawila Da Camara N. Which children and young people are at higher risk of severe disease and death after hospitalisation with SARS-CoV-2 infection in children and young people: A systematic review and individual patient meta-analysis. Clin Med. 2022;44:101.

Prabhu SS, Gavali VS, Mathur R. Clinical characteristics and predictive mortality risk factors in hospitalised children with COVID-19 illness during the first and second wave: single centre experiences from a tertiary paediatric hospital in Mumbai. Int J Contemp Pediatr. 2022;9(1):34-9.

LNJP hospital will function as dedicated COVID-19. Available at: https://timesofindia.indiatimes.com/city/ delhi/lnjp-hospital-will-function-as-dedicated-covid-19-hospital-union-health-minister/articleshow/ 74984186.cms. Accessed on 6 July 2021.

Strategy for COVID-19 testing in India (Version 4). Available at: https://www.icmr.gov.in/pdf/covid/ strategy/Strategey_for_COVID19_Test_v4_09042020.pdf. Accessed on 6 July 2021.

Pocket book of COVID-19. Ministry of health and family welfare. Available at: https://www.mohfw. gov.in/pdf/3Pocketbookof5_Covid19_27March.pdf. Accessed on 6 July 2021.

Updated Clinical Management Protocol for COVID-19. Available at: https://www.mohfw.gov.in/pdf/ UpdatedClinicalManagementProtocolforCOVID19dated03072020.pdf. Accessed on 6 July 2021.

COVID-19 Management For 1 Month - 19 Years Old: Statement by Indian Academy of Pediatrics. Last accessed 18 Sept 21. Available at: https://iapindia. org/pdf/yOQBzDmtbU4R05M_IAP%20Covid%2019%20managementGuidelines%20for%20Pediatrician%20V1.1%20Apr%2027_2021%20(2).pdf. Accessed on 6 July 2021.

Stanley F. Reference intervals for laboratory tests and procedures. In: Kliegman RM, Geme JW, Blum NJ, eds. Nelson Textbook of Pediatrics. 21st ed. Elsevier, Philadelphia; 2019:2466.

Fore HH, Dongyu Q, Beasley DM. Child malnutrition and COVID-19: the time to act is now. Lancet. 2020; 396(10250):517-8.

Dong Y, Mo X, Hu Y. Epidemiology of COVID-19 Among Children in China. Pediatrics. 2020;145(6): e202.

Kelvin AA, Halperin S. COVID-19 in children: the link in the transmission chain. Lancet Infect Dis. 2020; 20:633-4.

Bitar RR, Alattas B, Azaz A. Gastrointestinal manifestations in children with COVID-19 infection: Retrospective tertiary center experience. Front Pediatr. 2022;10:925.

Krueger MB, Montenegro RC, de Araújo Coimbra PP. A wide spectrum of neurological manifestations in pediatrics patients with the COVID-19 infection: a case series. J Neurovirol. 2021;27(5):782-6.

Crisan-Dabija R, Grigorescu C, Pavel CA. Tuberculosis and COVID-19: Lessons from the Past Viral Outbreaks and Possible Future Outcomes. Can Respir J. 2020;2020:140.

Kurtz A, Grant K, Marano R, Arrieta A, Grant K, Feaster W, et al. Long-term effects of malnutrition on severity of COVID-19. Sci Rep. 2021;11(1):14974.

Roth J, Sahota N, Patel P. Obesity paradox, obesity orthodox, and the metabolic syndrome: an approach to unity. Mol Med. 2017;22:873‐85.

Kosmeri C, Koumpis E, Tsabouri S. Hematological manifestations of SARS-CoV-2 in children. Pediatr Blood Cancer. 2020;67(12):e287.

James PT, Ali Z, Armitage AE. The Role of Nutrition in COVID-19 Susceptibility and Severity of Disease: A Systematic Review. J Nutr. 2020:151(7):1854-78.

Liu L, She J, Bai Y, Liu W. SARS-CoV-2 Infection: Differences in Hematological Parameters Between Adults and Children. Int J Gen Med. 2021;14:3035-47.

Tsabouri S, Makis A, Kosmeri C. Risk factors for severity in children with coronavirus disease 2019. Pediatr Clin North Am. 2021;68:321-38.

Mahdizade Ari M, Mohamadi MH, Shadab Mehr N. Neurological manifestations in patients with COVID-19: A systematic review and meta-analysis. J Clin Lab Anal. 2022;36(5):e24.

Wang Y, Li Y, Zhang Y. Are gastrointestinal symptoms associated with higher risk of Mortality in COVID-19 patients? A systematic review and meta-analysis. BMC Gastroenterol. 2022;22:106.

Tian W, Jiang W, Yao J. Predictors of mortality in hospitalized COVID-19 patients: A systematic review and meta-analysis. J Med Virol. 2020;92:1875-83.

Prata-Barbosa A, Lima-Setta F, Santos GRD. Pediatric patients with COVID-19 admitted to intensive care units in Brazil: A prospective multicenter study. J Pediatr. 2020;96:582-92.

Rathod BD, Amle D, Khot RS. Neutrophil-to-Lymphocyte Ratio as a Predictor of Disease Severity and Mortality in Coronavirus Disease 2019: Prospective Study From Central India. Cureus. 2022; 14(3):e23.

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Published

2023-10-26

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Original Research Articles