Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.
Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Clin Infect Dis. 2024 Aug 16;79(2):395-404. doi: 10.1093/cid/ciae133.
We aimed to determine if pre-existing immunocompromising conditions (ICCs) were associated with the presentation or outcome of patients with acute coronavirus disease 2019 (COVID-19) admitted for pediatric intensive care.
Fifty-five hospitals in 30 US states reported cases through the Overcoming COVID-19 public health surveillance registry. Patients <21 years admitted 12 March 2020-30 December 2021 to the pediatric intensive care unit (PICU) or high-acuity unit for acute COVID-19 were included.
Of 1274 patients, 105 (8.2%) had an ICC, including 33 (31.4%) hematologic malignancies, 24 (22.9%) primary immunodeficiencies and disorders of hematopoietic cells, 19 (18.1%) nonmalignant organ failure with solid-organ transplantation, 16 (15.2%) solid tumors, and 13 (12.4%) autoimmune disorders. Patients with ICCs were older, had more underlying renal conditions, and had lower white blood cell and platelet counts than those without ICCs, but had similar clinical disease severity upon admission. In-hospital mortality from COVID-19 was higher (11.4% vs 4.6%, P = .005) and hospitalization was longer (P = .01) in patients with ICCs. New major morbidities upon discharge were not different between those with and without ICC (10.5% vs 13.9%, P = .40). In patients with ICCs, bacterial coinfection was more common in those with life-threatening COVID-19.
In this national case series of patients <21 years of age with acute COVID-19 admitted for intensive care, existence of a prior ICCs were associated with worse clinical outcomes. Reassuringly, most patients with ICCs hospitalized in the PICU for severe acute COVID-19 survived and were discharged home without new severe morbidities.
我们旨在确定预先存在的免疫功能低下情况（ICC）是否与接受儿科重症监护的急性 2019 年冠状病毒病（COVID-19）患者的表现或结局相关。
美国 30 个州的 55 家医院通过“克服 COVID-19”公共卫生监测登记处报告病例。纳入 2020 年 3 月 12 日至 2021 年 12 月 30 日期间因急性 COVID-19 收治至儿科重症监护病房（PICU）或高度急症病房的年龄<21 岁的患者。
在 1274 名患者中，有 105 名（8.2%）存在 ICC，包括 33 名（31.4%）血液系统恶性肿瘤患者、24 名（22.9%）原发性免疫缺陷和造血细胞疾病患者、19 名（18.1%）非恶性器官衰竭伴实体器官移植患者、16 名（15.2%）实体肿瘤患者和 13 名（12.4%）自身免疫性疾病患者。与无 ICC 患者相比，ICC 患者年龄更大，存在更多基础肾脏疾病，白细胞和血小板计数更低，但入院时临床疾病严重程度相似。ICC 患者的 COVID-19 院内死亡率更高（11.4% vs. 4.6%，P=0.005），住院时间更长（P=0.01）。出院时新发主要并发症在 ICC 患者和无 ICC 患者之间无差异（10.5% vs. 13.9%，P=0.40）。在 ICC 患者中，危及生命的 COVID-19 患者中细菌合并感染更为常见。
在这项针对因重症 COVID-19 收治入院的年龄<21 岁患者的全国性病例系列研究中，先前存在的 ICC 与较差的临床结局相关。令人安心的是，大多数因重症急性 COVID-19 入住 PICU 的 ICC 患者存活并出院回家，无新发严重并发症。
