新冠病毒病住院儿童的临床和流行病学特征：来自巴基斯坦的一项多中心纵向研究（2020年3月至2021年12月）
Clinical and epidemiological features of pediatric population hospitalized with COVID-19: a multicenter longitudinal study (March 2020-December 2021) from Pakistan.
作者信息
Abbas Qalab, Khalid Farah, Shahbaz Fatima Farrukh, Khan Javeria, Mohsin Shazia, Gowa Murtaza Ali, Shaikh Abdul Sattar, Asghar Rai Muhammad, Khalid Javairia, Karim Sehrish, Jehan Fyezah, Sadiq Masood, Rashid Junaid
机构信息
Assistant Professor, Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
Instructor, Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
出版信息
Lancet Reg Health Southeast Asia. 2023 Apr;11:100176. doi: 10.1016/j.lansea.2023.100176. Epub 2023 Mar 3.
BACKGROUND
We aimed to explore the epidemiological, clinical, and phenotypic parameters of pediatric patients hospitalized with COVID-19 in Pakistan.
METHODS
This longitudinal cohort study was conducted in five tertiary care hospitals in Pakistan from March 2020 to December 2021. Data on various epidemiological and clinical variables were collected using Case Report Forms (CRFs) adapted from the WHO COVID-19 clinical data platform at baseline and at monthly follow-ups for 3 months.
FINDINGS
A total of 1090 children were included. The median age was 5 years (Interquartile range 1-10), and the majority presented due to new signs/symptoms associated with COVID-19 (57.8%; n = 631), the most common being general and respiratory symptoms. Comorbidities were present in 417 (38.3%) children. Acute COVID-19 alone was found in 932 (85.5%) children, 81 (7.4%) had multisystem inflammatory syndrome (MIS-C), 77 (7.0%) had overlapping features of acute COVID-19 and MIS-C, and severe disease was found in 775/1086 (71.4%). Steroids were given to 351 (32.2%) patients while 77 (7.1%) children received intravenous immunoglobulins. Intensive care unit (ICU) care was required in 334 (31.6%) patients, and 203 (18.3%) deaths were reported during the study period. The largest spike in cases and mortality was from July to September 2021 when the Delta variant first emerged. During the first and second follow-ups, 37 and 10 children expired respectively, and medical care after discharge was required in 204 (25.4%), 94 (16.6%), and 70 (13.7%) children respectively during each monthly follow-up.
INTERPRETATION
Our study highlights that acute COVID-19 was the major phenotype associated with high severity and mortality in children in Pakistan in contrast to what has been observed globally.
FUNDING
The study was supported by the World Health Organization (WHO), which was involved in the study design but played no role in its analysis, writeup, or publication.
背景
我们旨在探究巴基斯坦因新冠肺炎住院的儿科患者的流行病学、临床和表型参数。
方法
这项纵向队列研究于2020年3月至2021年12月在巴基斯坦的五家三级医疗医院开展。使用从世界卫生组织新冠肺炎临床数据平台改编而来的病例报告表（CRF），在基线时以及之后3个月的每月随访中收集各种流行病学和临床变量的数据。
研究结果
共纳入1090名儿童。中位年龄为5岁（四分位间距1 - 10岁），大多数儿童因与新冠肺炎相关的新体征/症状就诊（57.8%；n = 631），最常见的是全身和呼吸道症状。417名（38.3%）儿童存在合并症。932名（85.5%）儿童仅患有急性新冠肺炎，81名（7.4%）患有多系统炎症综合征（MIS - C），77名（7.0%）具有急性新冠肺炎和MIS - C的重叠特征，775/1086名（71.4%）患有重症疾病。351名（32.2%）患者接受了类固醇治疗，77名（7.1%）儿童接受了静脉注射免疫球蛋白治疗。334名（31.6%）患者需要重症监护病房（ICU）护理，研究期间报告了203例（18.3%）死亡病例。病例数和死亡率的最大峰值出现在2021年7月至9月，即德尔塔变异株首次出现时。在第一次和第二次随访中，分别有37名和10名儿童死亡，在每次每月随访期间，分别有204名（25.4%）、94名（16.6%）和70名（13.7%）儿童出院后需要医疗护理。
解读
我们的研究强调，与全球观察到的情况不同，急性新冠肺炎是巴基斯坦儿童中与高严重程度和死亡率相关的主要表型。
资金支持
该研究由世界卫生组织（WHO）资助，WHO参与了研究设计，但在分析、撰写或发表过程中未发挥作用。
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