Predictors of mortality in children admitted with SARS‐CoV‐2 infection to a tertiary care hospital in North India

Abstract

Aim To compare the demographic, clinical, laboratory and radiological parameters of patients with different clinical outcomes (death or discharge) and analyse them to find out the potential predictors for mortality in children hospitalised with SARS‐CoV‐2 infection. Methods Retrospective chart review of all patients less than 18 years of age with laboratory‐confirmed SARS‐CoV‐2 infection and requiring hospital admission between 16 April 2020 and 31 October 2020. Results Of 255 children with SARS‐CoV‐2 infection, 100 patients (median age 62.5 months, 59% males, 70% with moderate to severe disease) were hospitalised, of whom 27 died (median age 72 months, 59% males and 30% severely underweight). The subgroup with comorbidities (n = 14) was older (median age 126 months) and had longer duration of stay (median 10 days). Fever and respiratory symptoms were comparable while gastrointestinal symptoms were more common among non‐survivors. Hypoxia at admission (odds ratio (OR) 5.48, P = 0.001), multiorgan dysfunction (OR 75.42, P = 0.001), presence of acute kidney injury (OR 11.66, P = 0.001), thrombocytopenia (OR 4.40, P = 0.003) and raised serum C‐reactive protein (CRP) (OR 4.69, P = 0.02) were independently associated with mortality. The median time from hospitalisation to death was 3 days. The deceased group had significantly higher median levels of inflammatory parameters and a higher incidence of complications (myocarditis, encephalitis, acute respiratory distress syndrome and shock). Conclusions Hypoxia at admission, involvement of three or more organ systems, presence of acute kidney injury, thrombocytopenia and raised serum C‐reactive protein were found to be independently associated with increased odds of in‐hospital mortality in children admitted with SARS‐CoV‐2 infection.

COVID-19 deaths in children and young people in England, March 2020 to December 2021: An active prospective national surveillance study

“…Our results are also in line with a recent systematic review up to May 2021, which also found higher odds of severe disease and death in CYP aged >10 years and underlying comorbidities, especially neurological or cardiac conditions [ 42 ], which is consistent with other published studies [ 11 , 15 , 42 , 43 ]. Notably, however, compared to children who died of other causes in England, previous analyses found that underlying health conditions were not overrepresented in children who died of COVID-19 [ 15 , 44 ], or among survivors and non-survivors in children hospitalised for COVID-19 [ 45 ].…”

Evaluation of a Hospitalized Pediatric COVID-19 Cohort from Indian National Clinical Registry of COVID-19

“…Such a figure is considerably lower than what is reported among hospitalized adult COVID-19 patients in India and abroad [ 12 , 16 , 17 ]. Other Indian reports on the pediatric population, mainly from tertiary care centers, have reported mortality ranging from 3.2% to 11.2% [ 6 , 18 , 19 ]. The present study, being a representative cohort, gives a holistic estimate of poor outcomes across treatment centers and the multiple waves of the pandemic.…”

Characterization of persons with reported SARS-CoV-2 infection in the Oklahoma City tri-county area: Evidence from the first 12 months of transmission

“…Although the role of comorbidities in relation to COVID-19 severity is relatively well understood, non-chronic symptomatic presentations at the time of testing have primarily been studied in relation to biomarkers and prognostic factors 21 , 22 , 23 rather than examining the association initial symptoms and later hospitalization or death. Our study demonstrates some of the first population-derived results on symptoms in a cohort of SARS-CoV-2 positive individuals, regardless of hospitalization status.…”