2019年冠状病毒病住院的儿科和成年患者的临床特征及结局：不同年龄层比较
Clinical Features and Outcomes of Pediatric and Adult Patients Hospitalized for Coronavirus Disease 2019: A Comparison Across Age Strata.
作者信息
Li Grace X, Gopchandani Komal, Brazer Noah, Tippett Ashley, Choi Chris, Hsiao Hui-Mien, Oseguera Miriam, Foresythe Abiodun, Bhattacharya Sanchita, Servellita Venice, Sotomayor Gonzalez Alicia, Spinler Jennifer K, Gonzalez Mark D, Gulick Dalia, Kraft Colleen, Kasinathan Vyjayanti, Wang Yun F Wayne, Dien Bard Jennifer, Chen Pei Ying, Flores-Vazquez Jessica, Odom John Audrey R, Planet Paul J, Devaraj Sridevi, Annapragada Ananth V, Luna Ruth Ann, Chiu Charles Y, Rostad Christina A
机构信息
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Department of Laboratory Medicine, Division of Infectious Diseases, University of California at San Francisco, San Francisco, CA, USA.
出版信息
Open Forum Infect Dis. 2024 Aug 10;11(8):ofae443. doi: 10.1093/ofid/ofae443. eCollection 2024 Aug.
BACKGROUND
Coronavirus disease 2019 (COVID-19) continues to cause hospitalizations and severe disease in children and adults.
METHODS
This study compared the risk factors, symptoms, and outcomes of children and adults hospitalized for COVID-19 from March 2020 to May 2023 across age strata at 5 US sites participating in the Predicting Viral-Associated Inflammatory Disease Severity in Children with Laboratory Diagnostics and Artificial Intelligence consortium. Eligible patients had an upper respiratory swab that tested positive for severe acute respiratory syndrome coronavirus 2 by nucleic acid amplification. Adjusted odds ratios (aOR) of clinical outcomes were determined for children versus adults, for pediatric age strata compared to adolescents (12-17 years), and for adult age strata compared to young adults (22-49 years).
RESULTS
Of 9101 patients in the Predicting Viral-Associated Inflammatory Disease Severity in Children with Laboratory Diagnostics and Artificial Intelligence cohort, 1560 were hospitalized for COVID-19 as the primary reason. Compared to adults (22-105 years, n = 675), children (0-21 years, n = 885) were less commonly vaccinated (14.3% vs 34.5%), more commonly infected with the Omicron variant (49.5% vs 26.1%) and had fewer comorbidities ( < .001 for most comparisons), except for lung disease ( = .24). After adjusting for confounding variables, children had significantly lower odds of receiving supplemental oxygen (aOR, 0.57; 95% confidence interval, .35-.92) and death (aOR, 0.011; 95% confidence interval, <.01-.58) compa--red to adults. Among pediatric age strata, adolescents 12-17 years had the highest odds of receiving supplemental oxygen, high-flow oxygen, and ICU admission. Among adults, those 50-64 years had the highest odds of mechanical ventilation and ICU admission.
CONCLUSIONS
Clinical outcomes of COVID-19 differed across pediatric and adult age strata. Adolescents experienced the most severe disease among children, whereas adults 50-64 years experienced the most severe disease among adults.
背景
2019冠状病毒病（COVID-19）继续导致儿童和成人住院及重症。
方法
本研究比较了2020年3月至2023年5月期间，美国5个参与“利用实验室诊断和人工智能预测儿童病毒相关炎症性疾病严重程度”联盟的地点，因COVID-19住院的各年龄层儿童和成人的风险因素、症状及预后。符合条件的患者上呼吸道拭子经核酸扩增检测严重急性呼吸综合征冠状病毒2呈阳性。确定了儿童与成人、儿科年龄层与青少年（12 - 17岁）以及成人年龄层与青年成人（22 - 49岁）临床结局的调整优势比（aOR）。
结果
在“利用实验室诊断和人工智能预测儿童病毒相关炎症性疾病严重程度”队列的9101例患者中，1560例因COVID-19作为主要原因住院。与成人（22 - 105岁，n = 675）相比，儿童（0 - 21岁，n = 885）接种疫苗的比例较低（14.3%对34.5%），感染奥密克戎变异株的比例较高（49.5%对26.1%），合并症较少（大多数比较中P <.001），肺部疾病除外（P =.24）。在调整混杂变量后，与成人相比，儿童接受补充氧气（aOR，0.57；95%置信区间，0.35 - 0.92）和死亡（aOR，0.011；95%置信区间，<0.01 - 0.58）的几率显著较低。在儿科年龄层中，12 - 17岁的青少年接受补充氧气、高流量氧气和入住重症监护病房的几率最高。在成人中，50 - 64岁的人接受机械通气和入住重症监护病房的几率最高。
结论
COVID-19的临床结局在儿科和成人年龄层有所不同。青少年在儿童中病情最严重，而50 - 64岁的成人在成人中病情最严重。
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