Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO.
Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, CO.
Pediatr Infect Dis J. 2021 Apr 1;40(4):e137-e145. doi: 10.1097/INF.0000000000003043.
There are limited pediatric data regarding severe COVID-19 disease. Our study aims to describe the epidemiology and identify risk factors for severe COVID-19 disease in children.
This is a retrospective cohort study among children with positive SARS-CoV-2 PCR from March to July 2020 at Children's Hospital Colorado. Risk factors for severe disease were analyzed as defined by hospital admission, respiratory support, or critical care. Univariable and multivariable analyses were conducted.
Among 454 patients identified with SARS-CoV-2, 191 (42.1%) were females, median age 11 years. Fifty-five percent of all patients identified as Hispanic compared with 29% among all hospital visits in 2019 (P < 0.0001). In multivariable analyses, age 0-3 months or >20 years [adjusted odds ratio (aOR), 7.85; P < 0.0001 and aOR, 5.1; P = 0.03, respectively], preterm birth history (aOR, 3.7; P = 0.03), comorbidities [including immunocompromise (aOR, 3.5; P = 0.004), gastrointestinal condition (aOR, 2.7; P = 0.009), diabetes (aOR, 6.6; P = 0.04), asthma (aOR, 2.2; P = 0.04)], and specific symptoms at presentation were predictors for admission. Age 0-3 months or >20 years, asthma, gastrointestinal condition, and similar symptoms at presentation were also predictors for respiratory support. Elevated C-reactive protein was associated with the need for critical care with median of 17.7 mg/dL (IQR, 5.3-22.9) versus 1.95 mg/dL (IQR, 0.7-5.5) among patients requiring critical versus no critical care (OR, 1.2; P = 0.02).
Extremes of age, comorbid conditions, and elevated CRP are predictors of severe disease in children. Findings from this study can inform pediatric providers and public health officials to tailor clinical management, pandemic planning, and resource allocation.
目前针对儿童严重 COVID-19 疾病的研究数据有限。本研究旨在描述其流行病学特征，并确定儿童严重 COVID-19 疾病的风险因素。
这是一项回顾性队列研究，纳入了 2020 年 3 月至 7 月科罗拉多儿童医院检测出 SARS-CoV-2 病毒 PCR 阳性的患儿。根据住院、呼吸支持或重症监护的情况，对严重疾病的风险因素进行了分析。进行了单变量和多变量分析。
在确定的 454 例 SARS-CoV-2 患儿中，191 例（42.1%）为女性，中位年龄为 11 岁。所有患儿中 55%为西班牙裔，而 2019 年所有住院患儿中这一比例为 29%（P<0.0001）。多变量分析显示，年龄在 0-3 个月或>20 岁（校正比值比[aOR]，7.85；P<0.0001 和 aOR，5.1；P=0.03）、早产史（aOR，3.7；P=0.03）、合并症[包括免疫功能低下（aOR，3.5；P=0.004）、胃肠道疾病（aOR，2.7；P=0.009）、糖尿病（aOR，6.6；P=0.04）、哮喘（aOR，2.2；P=0.04）]以及就诊时的特定症状，都是住院的预测因素。年龄在 0-3 个月或>20 岁、哮喘、胃肠道疾病以及就诊时出现类似症状，也是需要呼吸支持的预测因素。C 反应蛋白升高与需要重症监护相关，需要重症监护者的中位 CRP 水平为 17.7mg/dL（IQR，5.3-22.9），而无需重症监护者的中位 CRP 水平为 1.95mg/dL（IQR，0.7-5.5）（比值比[OR]，1.2；P=0.02）。
儿童年龄较大或较小、合并症以及 CRP 升高，是严重疾病的预测因素。本研究结果可为儿科医生和公共卫生官员提供参考，以便制定临床管理、大流行规划和资源分配方案。
