Factors Associated With COVID-19 Disease Severity in US Children and Adolescents
Factors Associated With COVID-19 Disease Severity in US Children and Adolescents
复制标题
DOI：
10.12788/jhm.3689
复制
发表时间：
2021-10-01
影响因子：
2.6
通讯作者：
Williams, Derek J.
中科院分区：
文献类型：
--
作者：
Antoon, James W.;Grijalva, Carlos G.;Williams, Derek J.
背景对儿童和青少年COVID-19疾病严重程度相关的临床因素知之甚少。方法我们于2020年4月至2020年9月期间在美国45家儿童医院对初步诊断为COVID-19的出院儿科患者进行了一项回顾性队列研究。我们在住院患者中评估了与住院相关的因素和与临床严重程度相关的因素（例如，入住住院楼层、入住重症监护室[ICU]、入住ICU并接受机械通气、休克、死亡）。结果在19，976例COVID-19遭遇中，15，913例（79.7%）患者从急诊科（艾德）出院，4063例（20.3%）住院。住院患者的临床严重程度分布为中度（3222，79.3%）、重度（431，11.3%）和极重度（380，9.4%）。与住院与从艾德出院相关的因素包括私人支付者保险（校正比值比[aOR]，1.16; 95% CI，1.1-1.3），肥胖/2型糖尿病（2型DM）（aOR，10.4; 95% CI，8.9-13.3），哮喘（aOR，1.4; 95% CI，1.3-1.6），心血管疾病，（aOR，5.0; 95% CI，4.3-5.8），免疫功能低下（aOR，5.9; 95% CI，5.0-6.7），肺部疾病（aOR，5.3; 95% CI，3.4-8.2）和神经系统疾病（aOR，3.2; 95% CI，2.7-5.8）。在因COVID-19住院的儿童和青少年中，疾病严重程度较高与黑人或其他非白人种族;年龄大于4岁;肥胖/2型糖尿病、心血管、神经肌肉和肺部疾病相关。在因COVID-19而到美国儿童医院急诊室就诊的儿童和青少年中，20%住院治疗;其中21%在ICU接受治疗。年龄较大的儿童和青少年住院的风险较低，但住院时病情更严重。不同人种和种族的疾病严重程度以及是否存在选定的合并症存在差异。在确定缓解和疫苗接种战略的优先次序时，应考虑到这些因素。
BACKGROUND Little is known about the clinical factors associated with COVID-19 disease severity in children and adolescents. METHODS We conducted a retrospective cohort study across 45 US children's hospitals between April 2020 to September 2020 of pediatric patients discharged with a primary diagnosis of COVID-19. We assessed factors associated with hospitalization and factors associated with clinical severity (eg, admission to inpatient floor, admission to intensive care unit [ICU], admission to ICU with mechanical ventilation, shock, death) among those hospitalized. RESULTS Among 19,976 COVID-19 encounters, 15,913 (79.7%) patients were discharged from the emergency department (ED) and 4063 (20.3%) were hospitalized. The clinical severity distribution among those hospitalized was moderate (3222, 79.3%), severe (431, 11.3%), and very severe (380, 9.4%). Factors associated with hospitalization vs discharge from the ED included private payor insurance (adjusted odds ratio [aOR],1.16; 95% CI, 1.1-1.3), obesity/type 2 diabetes mellitus (type 2 DM) (aOR, 10.4; 95% CI, 8.9-13.3), asthma (aOR, 1.4; 95% CI, 1.3-1.6), cardiovascular disease, (aOR, 5.0; 95% CI, 4.3-5.8), immunocompromised condition (aOR, 5.9; 95% CI, 5.0-6.7), pulmonary disease (aOR, 5.3; 95% CI, 3.4-8.2), and neurologic disease (aOR, 3.2; 95% CI, 2.7-5.8). Among children and adolescents hospitalized with COVID-19, greater disease severity was associated with Black or other non-White race; age greater than 4 years; and obesity/type 2 DM, cardiovascular, neuromuscular, and pulmonary conditions. CONCLUSIONS Among children and adolescents presenting to US children's hospital EDs with COVID-19, 20% were hospitalized; of these, 21% received care in the ICU. Older children and adolescents had a lower risk for hospitalization but more severe illness when hospitalized. There were differences in disease severity by race and ethnicity and the presence of selected comorbidities. These factors should be taken into consideration when prioritizing mitigation and vaccination strategies.