Department of Pediatrics, McGill University, Montreal, Quebec, Canada.
Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
BMJ Paediatr Open. 2022 Aug;6(1). doi: 10.1136/bmjpo-2022-001440.
To identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection.
Multicentre retrospective cohort study.
18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May 2021.
Children<18 years of age hospitalised for symptomatic PCR-positive SARS-CoV-2 infection, including PCR-positive multisystem inflammatory syndrome in children (MIS-C).
Severity on the WHO COVID-19 Clinical Progression Scale was used for ordinal logistic regression analyses.
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.
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.
确定因 SARS-CoV-2 感染住院的儿童发生重症的危险因素。
多中心回顾性队列研究。
2020 年 2 月 1 日至 2021 年 5 月 31 日期间，加拿大、伊朗和哥斯达黎加的 18 家医院。
因症状性 PCR 阳性 SARS-CoV-2 感染（包括 PCR 阳性儿童多系统炎症综合征，MIS-C）住院的<18 岁儿童。
采用世界卫生组织（WHO）COVID-19 临床进展量表对严重程度进行等级逻辑回归分析。
我们共确定了 403 例住院病例。中位年龄为 3.78 岁（IQR 0.53-10.77）。46.4%（187/403）存在至少一种合并症，18.6%（75/403）存在多种合并症。81 例（20.1%）儿童符合 WHO 标准的 PCR 阳性 MIS-C。25.3%（102/403）进展为 WHO 临床量表评分≥6。在调整年龄、胸部影像学表现、实验室确诊的细菌和/或病毒合并感染以及 MIS-C 诊断的多变量等级逻辑回归分析中，存在单一（调整比值比[aOR]1.90，95%CI 1.13-3.20）或多种慢性合并症（aOR 2.12，95%CI 1.19-3.79）、肥胖（aOR 3.42，95%CI 1.76-6.66）和染色体疾病（aOR 4.47，95%CI 1.25-16.01）是严重程度的独立危险因素。年龄不是独立的危险因素，但年龄分层调整分析中不同的特定年龄合并症与更严重的疾病相关：<12 岁的儿童存在心脏（aOR 2.90，95%CI 1.11-7.56）和非哮喘性肺部疾病（aOR 3.07，95%CI 1.26-7.49），≥12 岁的青少年存在肥胖症（aOR 3.69，1.45-9.40）。在<1 岁的婴儿中，神经（aOR 10.72，95%CI 1.01-113.35）和心脏疾病（aOR 10.13，95%CI 1.69-60.54）是严重疾病的独立预测因素。
我们确定了因 SARS-CoV-2 感染住院的儿童发生疾病严重程度的危险因素。使儿童易患更严重疾病的合并症可能因年龄而异。这些发现可能有助于指导儿童的疫苗接种计划和治疗方法。
