Risk factors for poor prognosis in children and adolescents with COVID-19: A systematic review and meta-analysis

Qianling Shi; Zijun Wang; Jiao Liu; Xingmei Wang; Qi Zhou; Qinyuan Li; Yang Yu; Zhengxiu Luo; Enmei Liu; Yaolong Chen; COVID-19 evidence and recommendations working group

doi:10.1016/j.eclinm.2021.101155

Risk factors for poor prognosis in children and adolescents with COVID-19: A systematic review and meta-analysis

EClinicalMedicine. 2021 Nov:41:101155. doi: 10.1016/j.eclinm.2021.101155. Epub 2021 Oct 19.

Authors

Qianling Shi^{1

2}, Zijun Wang^{2

3}, Jiao Liu^{4

5

6}, Xingmei Wang^{4

5

6}, Qi Zhou^{2

3}, Qinyuan Li^{4

5

6}, Yang Yu^{7

8}, Zhengxiu Luo^{4

5

6}, Enmei Liu^{4

5

6}, Yaolong Chen^{2

3

9

10

11

12

13}; COVID-19 evidence and recommendations working group

Affiliations

¹ The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China.
² Lanzhou University Institute of Health Data Science, Lanzhou 730000, China.
³ Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.
⁴ Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China.
⁵ National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China.
⁶ Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China.
⁷ Department of Tumor Surgery, Lanzhou University Second Hospital, Lanzhou 730000, China.
⁸ The Second School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China.
⁹ WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou 730000, China.
¹⁰ Lanzhou University GRADE Center, Lanzhou 730000, China.
¹¹ Guideline International Network Asia, Lanzhou 730000, China.
¹² Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China.
¹³ Affiliate of the Cochrane China Network, Lanzhou University, Lanzhou 730000, China.

Abstract

Background: This study provides the first systematic review and meta-analysis to identify the predictors of unfavorable prognosis of COVID-19 in children and adolescents.

Methods: We searched literature databases until July 2021 for studies that investigated risk factors for unfavorable prognosis of children and adolescents with COVID-19. We used random-effects models to estimate the effect size with 95% confidence interval (CI).

Findings: We identified 56 studies comprising 79,104 individuals. Mortality was higher in patients with multisystem inflammatory syndrome (MIS-C) (odds ratio [OR]=58.00, 95% CI 6.39-526.79) and who were admitted to intensive care (OR=12.64, 95% CI 3.42-46.68). Acute respiratry distress syndrme (ARDS) (OR=29.54, 95% CI 12.69-68.78) and acute kidney injury (AKI) (OR=55.02, 95% CI 6.26-483.35) increased the odds to be admitted to intensive care; shortness of breath (OR=16.96, 95% CI 7.66-37.51) increased the need of respiratory support; and neurological diseases (OR=5.16, 95% CI 2.30-11.60), C-reactive protein (CRP) level ≥80 mg/L (OR=11.70, 95% CI 4.37-31.37) and D-dimer level ≥0.5ug/mL (OR=20.40, 95% CI 1.76-236.44) increased the odds of progression to severe or critical disease.

Interpretation: Congenital heart disease, chronic pulmonary disease, neurological diseases, obesity, MIS-C, shortness of breath, ARDS, AKI, gastrointestinal symptoms, elevated CRP and D-dimer are associated with unfavourable prognosis in children and adolescents with COVID-19.

Keywords: Adolescents; COVID-19; Children; Meta-analysis; Prognosis; Risk factor.