Clinical characteristics and risk factors for death among hospitalised children and adolescents with COVID-19 in Brazil: an analysis of a nationwide database.
Clinical characteristics and risk factors for death among hospitalised children and adolescents with COVID-19 in Brazil: an analysis of a nationwide database.
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DOI：
10.1016/s2352-4642(21)00134-6
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发表时间：
2021-08
期刊：
影响因子：
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通讯作者：
Oliveira MCL
中科院分区：
文献类型：
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作者：
Oliveira EA;Colosimo EA;Simões E Silva AC;Mak RH;Martelli DB;Silva LR;Martelli-Júnior H;Oliveira MCL
COVID-19通常不太严重，儿童的病死率低于成人。我们的目的是了解因实验室确诊的SARS-CoV-2感染住院的儿童和青少年的临床特征，并评估该人群中COVID-19相关死亡的风险因素。我们分析了2020年2月16日至2021年1月9日期间所有年龄小于20岁、经定量RT-PCR确诊的COVID-19患者，并在流感流行病学监测信息系统（SIVEP-Gripe，巴西因严重急性呼吸道疾病住院患者的全国监测数据库）中登记。主要结局是至恢复（出院）或院内死亡的时间，通过使用累积发生率函数的竞争风险分析进行评价。在研究期间向SIVEP-Gripe报告的82055例20岁以下患者中，11613例（14.2%）有可用数据显示实验室确认的SARS-CoV-2感染，并被纳入样本。在这些患者中，886例（7.6%）在住院期间死亡（入院后中位数6天[IQR 3-15]），10041例（86.5%）患者出院，369例（3.2%）在分析时住院，317例（2.7%）结局信息缺失。在入院后的前10天内，估计死亡概率为4.8%，在前20天内为6.7%，在随访结束时为8.1%。前10天出院概率为54.1%，前20天为78.4%，随访结束时为92.0%。我们的竞争风险多变量生存分析显示，2岁以下婴儿的死亡风险增加（风险比2·36 [95% CI 1·94-2·88]）或12-19岁青少年（2·23 [1·84-2·71]）相对于2-11岁儿童;土著民族（3·36 [2·15-5·24]）相对于白色种族;生活在东北地区的人（2·06 [1·68-2·52]）或北部地区（1·55 [1·22-1·98]）相对于东南部地区;与无既往疾病的患者相比，有1种（2.96 [2.52 - 3.47]）、2种（4.96 [3.80 - 6.48]）或3种或3种以上（7.28 [4.56 - 11.6]）既往疾病的患者。COVID-19导致的死亡与年龄、原住民种族、地缘政治区域不佳以及先前存在的医疗状况有关。医疗保健、贫困和合并症方面的差异可能会导致巴西更弱势和社会经济弱势的儿童和青少年承受更大的COVID-19负担。国家科学和技术发展理事会、米纳斯吉拉斯研究支助基金会。
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. We 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. Of 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. 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. National Council for Scientific and Technological Development, Research Support Foundation of Minas Gerais.