Paediatric critical COVID-19 and mortality in a multinational prospective cohort

• Published in: Lancet Regional Health - Americas (Online) Vol. 12; p. 100272
• Main Authors: Camporesi, Anna, Dallefeld, Samantha, Francoeur, Conall, Gurbanov, Anar, Mazzillo-Vega, Liliana, Shein, Steven L., Yock-Corrales, Adriana, Karsies, Todd, Kendirli, Tanil, Sanders, Ronald, Polikoff, Lee, Whelan, Siobhan, Castro, Francisca, Pardo, Rosalba, Vega, Gonzalo, Yunge, Mauricio, Acevedo, Lorena, Ardila, Ivan Jose, Aranguiz, Diego, Alvarez-Olmos, MarthaI, Figueroa-Vargas, Arieth, Valencia-Benavides, Maribel, Roa, Juan David, Lasso-Palomino, Rubén, Franceschi, Alessia, Venthur, Carina, Gonzalez-Dambrauskas, Sebastian, Ampuero, Camila, Paco-Barral, Jhovana E., Tasayco-Muñoz, Jaime, Domínguez-Rojas, Jesús, Rafael-Patricio, Francisca, Pellegrini, Solana, Zuazaga, Marcela, Brusca, Silvana, Aguilera-Avendano, Vladmir Ivan, Alejandro, F., Thelma, E., Terán, M., Coronado-Lujan, Mariela, Diaz-Rubio, Franco, Cinquegrana, Karina, Sandoval, Alicia, Gonzalez, Andrea, Lopez-Alarcon, Yurika, Slöcker-Barrio, María, Urbano-Villaescusa, Javier, Mazzillo, Liliana, Giraldo, Beatriz, Castillo, Jorge Omar, Fabris, Juan Pablo, Paladino, Carolina, Sanabria, Silvia, Urena-Chavarría, Erika, Quispe, Gaudi, Munaico-Abanto, Manuel, Colombo, Miriam, Blanco, Ana Carola, Pineres-Olave, Byron Enrique, Correa, Patricia, Garcia-De-Jesus, Ricardo, Ferre, Arani, Pietroboni, Pietro, Mauricio-Cantillano, Edwin, Banegas-Pineda, Linda, Casson-Rodriguez, Nils, Cavagnaro, Agustin, Wegner, Adriana, Zemanate, Eliana, Beltran-Zuñiga, Emilce, Quiñonez, Deyanira, Valero, Leonardo, Repetur, Alejandra, Castellani, Pablo, Bordogna, Adriana, De-la-Hoz-Pastor, Alfredo, Obando-Belalcazar, Evelyn, Jabornisky, Roberto, Wen, Andy, Coates, Bria, Watson, Christopher, Mack, Elizabeth, Hong, Jahee, Pon, Steven, Dapul, Heda, Kangin, Murat, Vasquez-Hoyos, Pablo, Gertz, Shira, Ducharme-Crevier, Laurence, Harwayne-Gidansky, Ilana, Fonseca-Flores, Marisol, Nunez-Enriquez, Juan Carlos, Leon-Villanueva, Armando, Maria, Ledys, Muisyo, Teddy, Spaeder, Michael
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-08-2022; The Author(s). Published by Elsevier Ltd; Elsevier
• Subjects: COVID-19; Epidemiology; Mortality; Outcomes; Paediatric intensive care unit; COVID-19; Epidemiology; Mortality; Paediatric intensive care unit; Outcomes
• ISSN: 2667-193X; 2667-193X
• DOI: 10.1016/j.lana.2022.100272

To understand critical paediatric coronavirus disease 2019 (COVID-19) and evaluate factors associated with mortality in children from high and low-middle income countries.
Prospective, observational study of critically ill children hospitalised for COVID-19 in 18 countries throughout North America, Latin America, and Europe between April 1 and December 31, 2020. Associations with mortality were evaluated using logistic regression.
557 patients (median age, 8 years; 24% <2 years) were enrolled from 55 sites (63% Latin American). Half had comorbidities. Invasive (41%) or non-invasive (20%) ventilation and vasopressors (56%) were the most common support modalities. Hospital mortality was 10% and higher in children <2 years old (15%; odds ratio 1·94, 95%CI 1·08-3·49). Most who died had pulmonary disease. When adjusted for age, sex, region, and illness severity, mortality-associated factors included cardiac (aOR 2·89; 95%CI 1·2-6·94) or pulmonary comorbidities (aOR 4·43; 95%CI 1·70-11·5), admission hypoxemia (aOR 2·44; 95%CI 1·30-4·57), and lower respiratory symptoms (aOR 2·96; 95%CI 1·57-5·59). MIS-C (aOR 0·25; 95%CI 0·1-0·61) and receiving methylprednisolone (aOR 0·5; 95%CI 0·25-0·99), IVIG (aOR 0·32; 95%CI 0·16-0·62), or anticoagulation (aOR 0·49; 95%CI 0·25-0·95) were associated with lower mortality although these associations might be limited to children >2 years old.
We identified factors associated with COVID-19 mortality in critically ill children from both high and low-middle income countries, including higher mortality with younger age and COVID-related pulmonary disease but lower mortality in MIS-C. Further research is needed on optimal treatments for younger children and respiratory failure in paediatric COVID-19.
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