BMJ Paediatrics Open (Aug 2022)
Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children
- Jesse Papenburg,
- Dara Petel,
- Joan L Robinson,
- Shaun K Morris,
- Manish Sadarangani,
- Karina A Top,
- Ann Bayliss,
- Tammie Dewan,
- Ali Manafi,
- Ashley Roberts,
- Ari Bitnun,
- Rosie Scuccimarri,
- Helena Brenes-Chacon,
- Alejandra Soriano-Fallas,
- Rolando Ulloa-Gutierrez,
- Jacqueline Wong,
- Peter Gill,
- Michelle Barton,
- Jared Bullard,
- Adriana Yock-Corrales,
- Fatima Kakkar,
- Tilmann Schober,
- Chelsea Caya,
- Jennifer Bowes,
- Suzette Cooke,
- Rachel Dwilow,
- Tala El Tal,
- Cheryl Foo,
- Behzad Haghighi Aski,
- Janell Lautermilch,
- Marie-Astrid Lefebvre,
- Kirk Leifso,
- Nicole Le Saux,
- Alison Lopez,
- Joanna Merckx,
- Alireza Nateghian,
- Luc Panetta,
- Dominique Piché,
- Rupeena Purewal,
- Lea Restivo,
- Sarah Tehseen,
- Isabelle Viel-Theriault,
- Carmen Yea,
- Ann Yeh
Affiliations
- Jesse Papenburg
- McGill University Health Centre, Montreal, Quebec, Canada
- Dara Petel
- 1 Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
- Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Shaun K Morris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Manish Sadarangani
- Vaccine Evaluation Center, BC Children`s Hospital Research Institute, Vancouver, British Columbia, Canada
- Karina A Top
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada
- Ann Bayliss
- Trillium Health Partners, University of Toronto, Mississauga, Ontario, Canada
- Tammie Dewan
- Department of Paediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
- Ali Manafi
- 44 Plastic Surgery Department, Iran University of Medical Sciences, Tehran, Iran
- Ashley Roberts
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Ari Bitnun
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
- Rosie Scuccimarri
- 9McGill University Health Centre and McGill University, Montréal, Québec, Canada
- Helena Brenes-Chacon
- Universidad de Ciencias Medicas (UCIMED), San Jose, Costa Rica
- Alejandra Soriano-Fallas
- Universidad de Ciencias Medicas (UCIMED), San Jose, Costa Rica
- Rolando Ulloa-Gutierrez
- Universidad de Ciencias Medicas (UCIMED), San Jose, Costa Rica
- Jacqueline Wong
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Peter Gill
- 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Michelle Barton
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada
- Jared Bullard
- 2 Manitoba Health, Healthy Living, and Seniors, Winnipeg, Manitoba, Canada
- Adriana Yock-Corrales
- 5 Emergency Department, Hospital Nacional de Ninos, San Jose, Costa Rica
- Fatima Kakkar
- Pediatric Infectious Diseases, CHU Sainte-Justine, Montreal, Quebec, Canada
- Tilmann Schober
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Chelsea Caya
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Jennifer Bowes
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
- Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Cheryl Foo
- Department of Pediatrics, Memorial University of Newfoundland, St. John`s, Newfoundland and Labrador, Canada
- Behzad Haghighi Aski
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
- Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Marie-Astrid Lefebvre
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Kirk Leifso
- Department of Pediatrics, Queen`s University, Kingston, Ontario, Canada
- Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Alison Lopez
- British Columbia Children`s Hospital, Vancouver, British Columbia, Canada
- Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Alireza Nateghian
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
- Luc Panetta
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
- Dominique Piché
- Department of Pediatrics, Dalhousie University, Halifax, British Columbia, Canada
- Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Sarah Tehseen
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Isabelle Viel-Theriault
- Department of Pediatrics, CHU de Québec-Université Laval, Quebec, Canada
- Carmen Yea
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Ann Yeh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- DOI
- https://doi.org/10.1136/bmjpo-2022-001440
- Journal volume & issue
-
Vol. 6,
no. 1
Abstract
Objective To identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection.Design Multicentre retrospective cohort study.Setting 18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May 2021.Patients Children<18 years of age hospitalised for symptomatic PCR-positive SARS-CoV-2 infection, including PCR-positive multisystem inflammatory syndrome in children (MIS-C).Main outcome measure Severity on the WHO COVID-19 Clinical Progression Scale was used for ordinal logistic regression analyses.Results We identified 403 hospitalisations. Median age was 3.78 years (IQR 0.53–10.77). At least one comorbidity was present in 46.4% (187/403) and multiple comorbidities in 18.6% (75/403). Eighty-one children (20.1%) met WHO criteria for PCR-positive MIS-C. Progression to WHO clinical scale score ≥6 occurred in 25.3% (102/403). In multivariable ordinal logistic regression analyses adjusted for age, chest imaging findings, laboratory-confirmed bacterial and/or viral coinfection, and MIS-C diagnosis, presence of a single (adjusted OR (aOR) 1.90, 95% CI 1.13 to 3.20) or multiple chronic comorbidities (aOR 2.12, 95% CI 1.19 to 3.79), obesity (aOR 3.42, 95% CI 1.76 to 6.66) and chromosomal disorders (aOR 4.47, 95% CI 1.25 to 16.01) were independent risk factors for severity. Age was not an independent risk factor, but different age-specific comorbidities were associated with more severe disease in age-stratified adjusted analyses: cardiac (aOR 2.90, 95% CI 1.11 to 7.56) and non-asthma pulmonary disorders (aOR 3.07, 95% CI 1.26 to 7.49) in children<12 years old and obesity (aOR 3.69, 1.45–9.40) in adolescents≥12 years old. Among infants<1 year old, neurological (aOR 10.72, 95% CI 1.01 to 113.35) and cardiac disorders (aOR 10.13, 95% CI 1.69 to 60.54) were independent predictors of severe disease.Conclusion We identified risk factors for disease severity among children hospitalised for PCR-positive SARS-CoV-2 infection. Comorbidities predisposing children to more severe disease may vary by age. These findings can potentially guide vaccination programmes and treatment approaches in children.
