Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study
Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study
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DOI：
10.1136/bmj.m3249
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发表时间：
2020-08-27
影响因子：
105.7
通讯作者：
Semple, Malcolm G.
中科院分区：
文献类型：
--
作者：
Swann, Olivia, V;Holden, Karl A.;Semple, Malcolm G.
目的分析英国实验室确诊的严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）感染入院儿童和青少年的临床特征，探讨与冠状病毒病2019 (covid-19) （MIS-C）暂时相关的儿童和青少年重症监护入院、死亡率和多系统炎症综合征发展的相关因素。前瞻性观察队列研究，快速数据收集和近实时分析。在2020年1月17日至7月3日期间，在英格兰、威尔士和苏格兰的260家医院进行随访，随访时间至少为两周（至2020年7月17日）。参与者651名年龄在19岁以下的儿童和年轻人被138家医院收治，并被纳入国际严重急性呼吸道和紧急感染联盟（ISARIC）世卫组织临床特征协议英国研究，实验室确诊为SARS-CoV-2。主要结局指标：入住重症监护（高依赖性或重症监护），住院死亡率，或符合WHO对MIS-C的初步病例定义。结果患者年龄中位数为4.6岁（四分位间距0.3 ~ 13.7），未满12月龄占35%(225/651)，男性占56%（367/650）。57%（330/576）为白人，12%（67/576）为南亚人，10%（56/576）为黑人。42%（276/651）至少有一种记录的合并症。发现了系统性粘膜-皮肤-肠道群集症状，其中包括世卫组织misc标准的症状。18%（116/632）患儿进入重症监护。在多变量分析中，这与1个月以下的年龄（比值比3.21,95%可信区间1.36 ~ 7.66，P=0.008）、10 ~ 14岁的年龄（比值比3.23,1.55 ~ 6.99，P=0.002）和黑人种族（比值比2.82,1.41 ~ 5.57，P=0.003）有关。627例患者中有6例（1%）在医院死亡，所有患者均有严重的合并症。11%（52/456）符合世卫组织misc标准，首个患者于3月中旬出现症状。符合MIS-C标准的儿童年龄较大(中位年龄10.7 (8.3-14.1)v 1.6（0.2-12.9）岁；P
OBJECTIVETo characterise the clinical features of children and young people admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK and explore factors associated with admission to critical care, mortality, and development of multisystem inflammatory syndrome in children and adolescents temporarily related to coronavirus disease 2019 (covid-19) (MIS-C).DESIGNProspective observational cohort study with rapid data gathering and near real time analysis.SETTING260 hospitals in England, Wales, and Scotland between 17 January and 3 July 2020, with a minimum follow-up time of two weeks (to 17 July 2020).PARTICIPANTS651 children and young people aged less than 19 years admitted to 138 hospitals and enrolled into the International Severe Acute Respiratory and emergency Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK study with laboratory confirmed SARS-CoV-2.MAIN OUTCOME MEASURESAdmission to critical care (high dependency or intensive care), in-hospital mortality, or meeting the WHO preliminary case definition for MIS-C.RESULTSMedian age was 4.6 (interquartile range 0.3-13.7) years, 35% (225/651) were under 12 months old, and 56% (367/650) were male. 57% (330/576) were white, 12% (67/576) South Asian, and 10% (56/576) black. 42% (276/651) had at least one recorded comorbidity. A systemic mucocutaneousenteric cluster of symptoms was identified, which encompassed the symptoms for the WHO MIS-C criteria. 18% (116/632) of children were admitted to critical care. On multivariable analysis, this was associated with age under 1 month (odds ratio 3.21, 95% confidence interval 1.36 to 7.66; P=0.008), age 10-14 years (3.23, 1.55 to 6.99; P=0.002), and black ethnicity (2.82, 1.41 to 5.57; P=0.003). Six (1%) of 627 patients died in hospital, all of whom had profound comorbidity. 11% (52/456) met the WHO MIS-C criteria, with the first patient developing symptoms in mid-March. Children meeting MIS-C criteria were older (median age 10.7 (8.3-14.1) v 1.6 (0.2-12.9) years; P