Severe Acute Respiratory Syndrome Coronavirus 2 Clinical Syndromes and Predictors of Disease Severity in Hospitalized Children and Youth

J Pediatr. 2021 Mar;230:23-31.e10. doi: 10.1016/j.jpeds.2020.11.016. Epub 2020 Nov 14.

Abstract

Objective: To characterize the demographic and clinical features of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) syndromes and identify admission variables predictive of disease severity.

Study design: We conducted a multicenter, retrospective, and prospective study of pediatric patients hospitalized with acute SARS-CoV-2 infections and multisystem inflammatory syndrome in children (MIS-C) at 8 sites in New York, New Jersey, and Connecticut.

Results: We identified 281 hospitalized patients with SARS-CoV-2 infections and divided them into 3 groups based on clinical features. Overall, 143 (51%) had respiratory disease, 69 (25%) had MIS-C, and 69 (25%) had other manifestations including gastrointestinal illness or fever. Patients with MIS-C were more likely to identify as non-Hispanic black compared with patients with respiratory disease (35% vs 18%, P = .02). Seven patients (2%) died and 114 (41%) were admitted to the intensive care unit. In multivariable analyses, obesity (OR 3.39, 95% CI 1.26-9.10, P = .02) and hypoxia on admission (OR 4.01; 95% CI 1.14-14.15; P = .03) were predictive of severe respiratory disease. Lower absolute lymphocyte count (OR 8.33 per unit decrease in 109 cells/L, 95% CI 2.32-33.33, P = .001) and greater C-reactive protein (OR 1.06 per unit increase in mg/dL, 95% CI 1.01-1.12, P = .017) were predictive of severe MIS-C. Race/ethnicity or socioeconomic status were not predictive of disease severity.

Conclusions: We identified variables at the time of hospitalization that may help predict the development of severe SARS-CoV-2 disease manifestations in children and youth. These variables may have implications for future prognostic tools that inform hospital admission and clinical management.

Keywords: COVID-19; biomarkers.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Biomarkers / analysis
  • C-Reactive Protein / analysis
  • COVID-19 / blood
  • COVID-19 / epidemiology*
  • Child
  • Child, Preschool
  • Connecticut / epidemiology
  • Female
  • Hospitalization*
  • Humans
  • Hypoxia / epidemiology
  • Infant
  • Intensive Care Units
  • Lymphocyte Count
  • Male
  • Multivariate Analysis
  • New Jersey / epidemiology
  • New York / epidemiology
  • Pediatric Obesity / epidemiology
  • Procalcitonin / blood
  • Prospective Studies
  • Retrospective Studies
  • Severity of Illness Index*
  • Systemic Inflammatory Response Syndrome / blood
  • Systemic Inflammatory Response Syndrome / epidemiology*
  • Troponin / blood
  • Young Adult

Substances

  • Biomarkers
  • Procalcitonin
  • Troponin
  • C-Reactive Protein

Supplementary concepts

  • pediatric multisystem inflammatory disease, COVID-19 related