Risk factors for COVID ‐19‐related mortality in hospitalized children and adolescents with diabetes mellitus: An observational retrospective cohort study

Abstract

Background Diabetes has been recognized as a major comorbidity for COVID‐19 severity in adults. This study aimed to characterize the clinical outcomes and risk factors for COVID‐19‐related death in a large cohort of hospitalized pediatric patients with diabetes. Methods We performed an analysis of all pediatric patients with diabetes and COVID‐19 registered in SIVEP‐Gripe, a Brazilian nationwide surveillance database, between February 2020 and May 2021. The primary outcome was time to death, which was evaluated considering discharge as a competitive risk by using cumulative incidence function. Results Among 21,591 hospitalized pediatric patients with COVID‐19, 379 (1.8%) had diabetes. Overall, children and adolescents with diabetes had a higher prevalence of ICU admission (46.6% vs. 26%), invasive ventilation (16.9% vs. 10.3%), and death (15% vs. 7.6%) (all P < 0.0001). Children with diabetes had twice the hazard of death compared with pediatric patients without diabetes (Hazard ratio [HR] = 2.0, 95% CI, 1.58–2.66). Among children with diabetes, four covariates were independently associated with the primary outcome, living in the poorest regions of the country (Northeast, HR, 2.17, 95% CI 1.18–4.01, and North, (HR 4.0, 95% CI 1.79–8.94), oxygen saturation < 95% at admission (HR 2.97, 95% CI 1.64–5.36), presence of kidney disorders (HR 3.39, 95% CI 1.42–8.09), and presence of obesity (HR 3.77, 95% CI 1.83–7.76). Conclusion Children and adolescents with diabetes had a higher risk of death compared with patients without diabetes. The higher risk of death was associated with clinical and socioeconomic factors.

The association between pre‐existing asthma and reduced risk of death among children and adolescents hospitalized with COVID‐19 in Brazil

“…As observed in adult cohorts, the coexistence of comorbidities, including diabetes, obesity, kidney disease, and hematology/oncology, has been clearly associated with severe illness and mortality in pediatric patients with COVID-19. 3,[23][24][25][26] However, our results also showed a history of asthma without another associated underlying medical condition as a strong protective factor against fatal outcomes in children and adolescents hospitalized with SARS-CoV-2 infection during the first 2 years of the pandemic in Brazil. Notably, compared with healthy children, this group had an approximately 60% reduction in risk of death (HR = 0.39, 95% CI, 0.29-0.56).…”

“…We found that the presence of comorbidities and the presence of asthma associated with chronic medical conditions tripled and doubled the risk of death compared to healthy children. As observed in adult cohorts, the coexistence of comorbidities, including diabetes, obesity, kidney disease, and hematology/oncology, has been clearly associated with severe illness and mortality in pediatric patients with COVID‐19 3,23–26 …”

Mortalidade por COVID-19 no Brasil em distintos grupos etários: diferenciais entre taxas extremas de 2021 e 2022

“…Em geral, as estimativas pontuais no grupo de SE 4-6/2022 foram maiores do que nos grupos de SE de 2021, mas com estimativas intervalares semelhantes. Avaliação da mortalidade por COVID-19 em crianças e adolescentes hospitalizados no Brasil sugere que, assim como em adultos, comorbidades como diabetes são um importante fator de risco para o óbito, sobretudo em contexto de precária condição socioeconômica e de inadequado suporte médico-hospitalar 12 .…”

Clinical Outcomes of Omicron Variant (B.1.1.529) Infection in Children and Adolescents Hospitalized With COVID-19 in Brazil With Observational Data on the Efficacy of the Vaccines in Adolescents

“…21 Among them, diabetes, obesity, and several other chronic disorders, have unanimously emerged as predictors of unfavorable outcomes. [21][22][23][24][25][26][27][28][29] For instance, two large US cohorts have recently shown the relationship between the severity of COVID-19 and comorbidities. Kompaniyets et al 30 reported data from 800 US hospitals with a cohort of about 43,000 children and adolescents.…”