Comparison of the First and Second Waves of the Coronavirus Disease 2019 Pandemic in Children and Adolescents in a Middle-Income Country: Clinical Impact Associated with Severe Acute Respiratory Syndrome Coronavirus 2 Gamma Lineage.
Comparison of the First and Second Waves of the Coronavirus Disease 2019 Pandemic in Children and Adolescents in a Middle-Income Country: Clinical Impact Associated with Severe Acute Respiratory Syndrome Coronavirus 2 Gamma Lineage.
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DOI：
10.1016/j.jpeds.2022.01.001
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发表时间：
2022-05
期刊：
影响因子：
--
通讯作者：
Martelli-Júnior H
中科院分区：
文献类型：
--
作者：
Oliveira EA;Simões E Silva AC;Oliveira MCL;Colosimo EA;Mak RH;Vasconcelos MA;Miranda DM;Martelli DB;Silva LR;Pinhati CC;Martelli-Júnior H
评估巴西因 COVID-19 住院的儿童和青少年中 SARS-CoV-2 伽玛变体的严重程度和临床结果。在这项观察性回顾性队列研究中，我们对巴西国家数据库中登记的所有 21 591 名年龄 <20 岁、确诊感染 SARS-CoV-2 的住院患者进行了分析。根据 SARS-CoV-2 谱系的优势，该队列被分为 2 组（WAVE1，n = 11 574；WAVE2，n = 10 017）。感兴趣的特征是年龄、性别、地理区域、种族、临床表现和合并症。主要结局是死亡时间，使用累积发生率函数通过竞争风险分析进行评估。基于 WAVE1 队列开发了预测性 Fine 和 Gray 竞争风险模型，并在 WAVE2 队列中进行了时间验证。与第一波期间入院的儿童和青少年相比，第二波期间入院的儿童和青少年的低氧血症率明显更高（52.5% vs 41.1%；P <.0001），入住重症监护室的人数（28.3% vs 24.9%；P <.0001）明显更高，并且需要更多的无创通气支持（37.3% vs 31.6%；P <.0001）。第一波中的院内死亡人数和死亡率分别为 896 例 (7.7%) 和第二波中的 765 例 (7.6%) (P = .07)。死亡预测模型包括年龄、种族、地区、呼吸道症状和合并症。在验证集 (WAVE2) 中，C 统计量为 0.750（95% CI，0.741-0.758；P < .0001）。这项大型全国性研究发现，由 γ 变异引起的 COVID-19 儿科患者面临更严重的风险。然而，各波之间的死亡概率没有差异。
To evaluate the severity and clinical outcomes of the SARS-CoV-2 gamma variant in children and adolescents hospitalized with COVID-19 in Brazil. In this observational retrospective cohort study, we performed an analysis of all 21 591 hospitalized patients aged <20 years with confirmed SARS-CoV-2 infection registered in a national database in Brazil. The cohort was divided into 2 groups according to the predominance of SARS-CoV-2 lineages (WAVE1, n = 11 574; WAVE2, n = 10 017). The characteristics of interest were age, sex, geographic region, ethnicity, clinical presentation, and comorbidities. The primary outcome was time to death, which was evaluated by competing-risks analysis, using cumulative incidence functions. A predictive Fine and Gray competing-risks model was developed based on the WAVE1 cohort with temporal validation in the WAVE2 cohort. Compared with children and adolescents admitted during the first wave, those admitted during the second wave had significantly more hypoxemia (52.5% vs 41.1%; P < .0001) and intensive care unit admissions (28.3% vs 24.9%; P < .0001) and needed more noninvasive ventilatory support (37.3% vs 31.6%; P < .0001). In-hospital deaths and death rates were 896 (7.7%) in the first wave and 765 (7.6%) in the second wave (P = .07). The prediction model of death included age, ethnicity, region, respiratory symptoms, and comorbidities. In the validation set (WAVE2), the C statistic was 0.750 (95% CI, 0.741-0.758; P < .0001). This large national study found a more severe spectrum of risk for pediatric patients with COVID-19 caused by the gamma variant. However, there was no difference regarding the probability of death between the waves.
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DOI：
10.1016/s2352-4642(21)00134-6
发表时间：
2021-08
期刊：
The Lancet. Child & adolescent health
影响因子：
--
作者：
Oliveira EA;Colosimo EA;Simões E Silva AC;Mak RH;Martelli DB;Silva LR;Martelli-Júnior H;Oliveira MCL
通讯作者：
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影响因子：
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