Clinical characteristics and risk factors for death among hospitalised children and adolescents with COVID-19 in Brazil: an analysis of a nationwide database

Abstract

Background COVID-19 is usually less severe and has lower case fatality in children than in adults. We aimed to characterise the clinical features of children and adolescents hospitalised with laboratory-confirmed SARS-CoV-2 infection and to evaluate the risk factors for COVID-19-related death in this population. MethodsWe did an analysis of all patients younger than 20 years who had quantitative RT-PCR-confirmed COVID-19 and were registered in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe, a nationwide surveillance database of patients admitted to hospital with severe acute respiratory disease in Brazil), between Feb 16, 2020, and Jan 9, 2021. The primary outcome was time to recovery (discharge) or in-hospital death, evaluated by competing risks analysis using the cumulative incidence function. FindingsOf the 82 055 patients younger than 20 years reported to SIVEP-Gripe during the study period, 11 613 (14•2%) had available data showing laboratory-confirmed SARS-CoV-2 infection and were included in the sample. Among these patients, 886 (7•6%) died in hospital (at a median 6 days [IQR 3-15] after hospital admission), 10 041 (86•5%) patients were discharged from the hospital, 369 (3•2%) were in hospital at the time of analysis, and 317 (2•7%) were missing information on outcome. The estimated probability of death was 4•8% during the first 10 days after hospital admission, 6•7% during the first 20 days, and 8•1% at the end of follow-up. Probability of discharge was 54•1% during the first 10 days, 78•4% during the first 20 days, and 92•0% at the end of follow-up. Our competing risks multivariate survival analysis showed that risk of death was increased in infants younger than 2 years (hazard ratio 2•36 [95% CI 1•94-2•88]) or adolescents aged 12-19 years (2•23 [1•84-2•71]) relative to children aged 2-11 years; those of Indigenous ethnicity (3•36 [2•15-5•24]) relative to those of White ethnicity; those living in the Northeast region (2•06 [1•68-2•52]) or North region (1•55 [1•22-1•98]) relative to those in the Southeast region; and those with one (2•96 [2•52-3•47]), two (4•96 [3•80-6•48]), or three or more (7•28 [4•56-11•6]) pre-existing medical conditions relative to those with none.Interpretation Death from COVID-19 was associated with age, Indigenous ethnicity, poor geopolitical region, and pre-existing medical conditions. Disparities in health care, poverty, and comorbidities can contribute to magnifying the burden of COVID-19 in more vulnerable and socioeconomically disadvantaged children and adolescents in Brazil.

Risk factors for COVID-19 mortality in hospitalised children and adolescents in Brazil – Authors' reply

“…We thank Jonas Carneiro Cruz and colleagues and Siyu Chen and Yong Shao for their interest in our study in The Lancet Child & Adolescent Health . 1 Here, we further discuss some findings and methodological aspects, specifically the question of the effect of age and comorbidities in the prognosis of paediatric COVID-19.…”

Risk factors for COVID-19 mortality in hospitalised children and adolescents in Brazil

“…There was also no internal validation or cross-validation. Therefore, we believe that our concerns should affect how the data presented by Oliveira and colleagues 1 should be interpreted.…”

“…We read with great interest the work by Eduardo Oliveira and colleagues, 1 who used a multivariate survival analysis to estimate the risk factors for COVID-19 mortality among children and adolescents admitted to hospital in Brazil. The study has important implications to guide policy and improve care of individuals at increased risk of death.…”

Risk factors for COVID-19 mortality in hospitalised children and adolescents in Brazil

“…We read the Article by Eduardo Oliveira and colleagues 1 with great interest and believe the findings from this cohort study are important, given that they directly investigated the risk factors associated with COVID-19 in children and adolescents.…”

“…Defining adolescence as age 10–24 years has been proposed to align more closely with adolescents’ biological growth and social-role transitions, 2 and some studies on COVID-19 have included patients aged 0–24 years. 4 The study by Oliveira and colleagues 1 included patients younger than 20 years, and the inclusion of patients aged 21–24 years might provide a more comprehensive understanding of COVID-19 in adolescence.…”