印度三级医疗中心收治的儿童新冠病毒病的严重程度及死亡率：一项队列研究
Severity and mortality associated with COVID-19 among children hospitalised in tertiary care centres in India: a cohort study.
作者信息
Gupta Vidushi, Singh Amitabh, Ganju Sheetal, Singh Raghvendra, Thiruvengadam Ramachandran, Natchu Uma Chandra Mouli, Gupta Nitesh, Kaushik Deepali, Chanana Surbhi, Sharma Dharmendra, Gosain Mudita, Rao Suman Pn, Pandey Narendra, Gupta Arvind, Singh Sandeep, Jhamb Urmila, Annayappa Venkatesh Lalitha, Dinakar Chitra, Pandey Anil Kumar, Gera Rani, Chellani Harish, Wadhwa Nitya, Bhatnagar Shinjini
机构信息
Translational Health Science and Technology Institute (THSTI), Faridabad, India.
Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC & SJH), New Delhi, India.
出版信息
Lancet Reg Health Southeast Asia. 2023 Jun;13:100203. doi: 10.1016/j.lansea.2023.100203. Epub 2023 Apr 18.
BACKGROUND
It is critical to identify high-risk groups among children with COVID-19 from low-income and middle-income countries (LMICs) to facilitate the optimum use of health system resources. The study aims to describe the severity and mortality of different clinical phenotypes of COVID-19 in a large cohort of children admitted to tertiary care hospitals in India.
METHODS
Children aged 0-19 years with evidence of SARS-CoV-2 infection (real time polymerase chain reaction or rapid antigen test positive) or exposure (anti-SARS-CoV-2 antibody, or history of contact with SARS-CoV-2) were enrolled in the study, between January 2021 and March 2022 across five tertiary hospitals in India. All study participants enrolled prospectively and retrospectively were followed up for three months after discharge. COVID-19 was classified into severe (Multisystem Inflammatory Syndrome in Children (MIS-C), severe acute COVID-19, 'unclassified') or non-severe disease. The mortality rates were estimated in different phenotypes.
FINDINGS
Among 2468 eligible children enrolled, 2148 were hospitalised. Signs of illness were present in 1688 (79%) children with 1090 (65%) having severe disease. High mortality was reported in MIS-C (18.6%), severe acute COVID-19 (13.3%) and the unclassified severe COVID-19 disease (12.3%). Mortality remained high (17.5%) when modified MIS-C criteria was used. Non-severe COVID-19 disease had 14.1% mortality when associated with comorbidity.
INTERPRETATION
Our findings have important public health implications for low resource settings. The high mortality underscores the need for better preparedness for timely diagnosis and management of COVID-19. Children with associated comorbidity or coinfections are a vulnerable group and need special attention. MIS-C requires context specific diagnostic criteria for low resource settings. It is important to evaluate the clinical, epidemiological and health system-related risk factors associated with severe COVID-19 and mortality in children from LMICs.
FUNDING
Department of Biotechnology, Govt of India and Department of Maternal, Child and Adolescent Health and Aging, WHO, Geneva, Switzerland.
背景
识别来自低收入和中等收入国家（LMICs）的新冠病毒病（COVID-19）儿童中的高危群体，对于促进卫生系统资源的优化利用至关重要。本研究旨在描述印度三级医院收治的一大群儿童中COVID-19不同临床表型的严重程度和死亡率。
方法
2021年1月至2022年3月期间，在印度的五家三级医院，将0至19岁有严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染证据（实时聚合酶链反应或快速抗原检测呈阳性）或接触史（抗SARS-CoV-2抗体，或接触SARS-CoV-2病史）的儿童纳入研究。所有前瞻性和回顾性纳入的研究参与者在出院后随访三个月。COVID-19分为重症（儿童多系统炎症综合征（MIS-C）、重症急性COVID-19、“未分类”）或非重症疾病。估计不同表型的死亡率。
结果
在纳入的2468名符合条件的儿童中，2148名住院。1688名（79%）儿童有疾病体征，其中1090名（65%）患有重症疾病。据报告，MIS-C（18.6%）、重症急性COVID-19（13.3%）和未分类的重症COVID-19疾病（12.3%）的死亡率较高。使用改良的MIS-C标准时，死亡率仍然很高（17.5%）。非重症COVID-19疾病合并症时死亡率为14.1%。
解读
我们的研究结果对资源匮乏地区具有重要的公共卫生意义。高死亡率凸显了对COVID-19进行及时诊断和管理的更好准备的必要性。合并症或合并感染的儿童是弱势群体，需要特别关注。MIS-C在资源匮乏地区需要针对具体情况的诊断标准。评估与LMICs儿童重症COVID-19和死亡率相关的临床、流行病学和卫生系统相关风险因素非常重要。
资助
印度政府生物技术部以及瑞士日内瓦世界卫生组织孕产妇、儿童和青少年卫生与老龄化司。
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