Characteristics, Outcomes, and Severity Risk Factors Associated With SARS-CoV-2 Infection Among Children in the US National COVID Cohort Collaborative.
Characteristics, Outcomes, and Severity Risk Factors Associated With SARS-CoV-2 Infection Among Children in the US National COVID Cohort Collaborative.
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DOI：
10.1001/jamanetworkopen.2021.43151
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发表时间：
2022-02-01
影响因子：
13.8
通讯作者：
Bennett TD
中科院分区：
文献类型：
--
作者：
Martin B;DeWitt PE;Russell S;Anand A;Bradwell KR;Bremer C;Gabriel D;Girvin AT;Hajagos JG;McMurry JA;Neumann AJ;Pfaff ER;Walden A;Wooldridge JT;Yoo YJ;Saltz J;Gersing KR;Chute CG;Haendel MA;Moffitt R;Bennett TD
在国家COVID队列协作中，SARS-CoV-2儿童的特征、随时间的变化、结局和严重性风险因素是什么？在这项队列研究中，56个地点的167262名儿童为SARS-CoV-2阳性，10245人住院。一些人口统计学和合并症变量和许多初始生命体征和实验室检查值与较高的疾病严重程度峰值相关。这项研究指出了临床数据元素，可以帮助早期识别由于SARS-CoV-2感染而处于严重疾病风险中的儿童。对美国儿童SARS-CoV-2感染的了解受到缺乏大规模多中心研究的限制。研究国家COVID队列协作（N3 C）中SARS-CoV-2儿童的特征、随时间的变化、结局和严重程度风险因素。在美国各地的56个N3 C设施中进行了一项前瞻性队列研究，研究结束日期为2021年9月24日之前。参与者包括在初始SARS-CoV-2测试时年龄小于19岁的儿童。随时间推移的病例发生率和严重程度、人口统计学和合并症严重程度风险因素、生命体征和实验室轨迹、临床结局、儿童急性COVID-19与多系统炎症综合征（MIS-C）以及SARS-CoV-2儿童的Delta与前Delta变异差异。共有1 068 410名儿童接受了SARS-CoV-2检测，167 262名（15.6%）检测结果呈阳性（82 882名[49.6%]女孩;中位年龄为11.9 [IQR，6.0-16.1]岁）。在10245例住院儿童（6.1%）中，1423例（13.9%）符合重度疾病标准：机械通气（796例[7.8%]）、血管加压剂-正性肌力支持（868例[8.5%]）、体外膜肺氧合（42例[0.4%]）或死亡（131例[1.3%]）。男性（比值比[OR]，1.37; 95%CI，1.21-1.56）、黑人/非裔美国人（OR，1.25; 95%CI，1.06-1.47）、肥胖（OR，1.19; 95%CI，1.01-1.41）和几种儿科复杂慢性疾病（PCCC）亚类与更高严重程度的疾病相关。入院当天的生命体征和许多实验室检查值可预测疾病严重程度峰值。与MIS-C与急性COVID-19相比几率增加相关的变量包括男性（OR，1.59; 95% CI，1.33-1.90），黑人/非裔美国人（OR，1.44; 95% CI，1.17-1.77），小于12岁（OR，1.81; 95% CI，1.51-2.18），肥胖（OR，1.76; 95%CI，1.40-2.22），并且没有儿科复杂慢性疾病（OR，0.72; 95%CI，0.65-0.80）。MIS-C患儿有更多的炎症实验室特征和严重的临床表型，有创通气率更高（117/707 [16.5%] vs 514/8241 [6.2%]; P < .001）和需要血管活性-变力性支持（707人中的191人[27.0%] vs 8241人中的426人[5.2%]; P < .001）与急性COVID-19患者相比。比较Delta与前Delta时代的儿童，住院率没有显著变化（1738 [6.0%] vs 8507 [6.2%]; P = 0.18）和较低的严重疾病几率（179例[10.3%] vs 1242例[14.6%]）（降低0.67倍; 95% CI，0.57-0.79; P < .001）。在这项针对美国SARS-CoV-2儿童的队列研究中，观察到严重程度亚组之间的人口统计学特征、既存合并症以及初始生命体征和实验室值存在差异。总之，这些结果表明，早期识别的儿童可能进展到严重的疾病可以实现从入院之日起使用现成的数据元素。需要进一步开展工作，将这些知识转化为更好的成果。这项队列研究检查了可能在估计SARS-CoV-2感染儿童的严重程度和结局方面具有实用性的因素。
What are the characteristics, changes over time, outcomes, and severity risk factors of children with SARS-CoV-2 within the National COVID Cohort Collaborative? In this cohort study, 167 262 children at 56 sites were SARS-CoV-2–positive and 10 245 were hospitalized. Several demographic and comorbidity variables and many initial vital sign and laboratory test values were associated with higher peak illness severity. This study noted clinical data elements that could assist with early identification of children at risk for severe disease due to SARS-CoV-2 infection. Understanding of SARS-CoV-2 infection in US children has been limited by the lack of large, multicenter studies with granular data. To examine the characteristics, changes over time, outcomes, and severity risk factors of children with SARS-CoV-2 within the National COVID Cohort Collaborative (N3C). A prospective cohort study of encounters with end dates before September 24, 2021, was conducted at 56 N3C facilities throughout the US. Participants included children younger than 19 years at initial SARS-CoV-2 testing. Case incidence and severity over time, demographic and comorbidity severity risk factors, vital sign and laboratory trajectories, clinical outcomes, and acute COVID-19 vs multisystem inflammatory syndrome in children (MIS-C), and Delta vs pre-Delta variant differences for children with SARS-CoV-2. A total of 1 068 410 children were tested for SARS-CoV-2 and 167 262 test results (15.6%) were positive (82 882 [49.6%] girls; median age, 11.9 [IQR, 6.0-16.1] years). Among the 10 245 children (6.1%) who were hospitalized, 1423 (13.9%) met the criteria for severe disease: mechanical ventilation (796 [7.8%]), vasopressor-inotropic support (868 [8.5%]), extracorporeal membrane oxygenation (42 [0.4%]), or death (131 [1.3%]). Male sex (odds ratio [OR], 1.37; 95% CI, 1.21-1.56), Black/African American race (OR, 1.25; 95% CI, 1.06-1.47), obesity (OR, 1.19; 95% CI, 1.01-1.41), and several pediatric complex chronic condition (PCCC) subcategories were associated with higher severity disease. Vital signs and many laboratory test values from the day of admission were predictive of peak disease severity. Variables associated with increased odds for MIS-C vs acute COVID-19 included male sex (OR, 1.59; 95% CI, 1.33-1.90), Black/African American race (OR, 1.44; 95% CI, 1.17-1.77), younger than 12 years (OR, 1.81; 95% CI, 1.51-2.18), obesity (OR, 1.76; 95% CI, 1.40-2.22), and not having a pediatric complex chronic condition (OR, 0.72; 95% CI, 0.65-0.80). The children with MIS-C had a more inflammatory laboratory profile and severe clinical phenotype, with higher rates of invasive ventilation (117 of 707 [16.5%] vs 514 of 8241 [6.2%]; P < .001) and need for vasoactive-inotropic support (191 of 707 [27.0%] vs 426 of 8241 [5.2%]; P < .001) compared with those who had acute COVID-19. Comparing children during the Delta vs pre-Delta eras, there was no significant change in hospitalization rate (1738 [6.0%] vs 8507 [6.2%]; P = .18) and lower odds for severe disease (179 [10.3%] vs 1242 [14.6%]) (decreased by a factor of 0.67; 95% CI, 0.57-0.79; P < .001). In this cohort study of US children with SARS-CoV-2, there were observed differences in demographic characteristics, preexisting comorbidities, and initial vital sign and laboratory values between severity subgroups. Taken together, these results suggest that early identification of children likely to progress to severe disease could be achieved using readily available data elements from the day of admission. Further work is needed to translate this knowledge into improved outcomes. This cohort study examines factors that may have utility in estimating severity and outcomes of children with SARS-CoV-2 infection.
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DOI：
10.1056/nejmoa2022926
发表时间：
2020-11-19
期刊：
The New England journal of medicine
影响因子：
--
作者：
RECOVERY Collaborative Group;Horby P;Mafham M;Linsell L;Bell JL;Staplin N;Emberson JR;Wiselka M;Ustianowski A;Elmahi E;Prudon B;Whitehouse T;Felton T;Williams J;Faccenda J;Underwood J;Baillie JK;Chappell LC;Faust SN;Jaki T;Jeffery K;Lim WS;Montgomery A;Rowan K;Tarning J;Watson JA;White NJ;Juszczak E;Haynes R;Landray MJ
通讯作者：
Landray MJ
影响因子：
15.1
作者：
Geva A;Patel MM;Newhams MM;Young CC;Son MBF;Kong M;Maddux AB;Hall MW;Riggs BJ;Singh AR;Giuliano JS;Hobbs CV;Loftis LL;McLaughlin GE;Schwartz SP;Schuster JE;Babbitt CJ;Halasa NB;Gertz SJ;Doymaz S;Hume JR;Bradford TT;Irby K;Carroll CL;McGuire JK;Tarquinio KM;Rowan CM;Mack EH;Cvijanovich NZ;Fitzgerald JC;Spinella PC;Staat MA;Clouser KN;Soma VL;Dapul H;Maamari M;Bowens C;Havlin KM;Mourani PM;Heidemann SM;Horwitz SM;Feldstein LR;Tenforde MW;Newburger JW;Mandl KD;Randolph AG;Overcoming COVID-19 Investigators
通讯作者：
Overcoming COVID-19 Investigators
DOI：
10.1016/j.cmi.2020.07.041
发表时间：
2021-01
期刊：
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
影响因子：
--
作者：
Garcia-Vidal C;Sanjuan G;Moreno-García E;Puerta-Alcalde P;Garcia-Pouton N;Chumbita M;Fernandez-Pittol M;Pitart C;Inciarte A;Bodro M;Morata L;Ambrosioni J;Grafia I;Meira F;Macaya I;Cardozo C;Casals C;Tellez A;Castro P;Marco F;García F;Mensa J;Martínez JA;Soriano A;COVID-19 Researchers Group
通讯作者：
COVID-19 Researchers Group
影响因子：
120.7
作者：
Feldstein, Leora R.;Tenforde, Mark W.;Randolph, Adrienne G.
通讯作者：
Randolph, Adrienne G.
影响因子：
36.4
作者：
Goetzinger, Florian;Santiago-Garcia, Begona;Tebruegge, Marc
通讯作者：
Tebruegge, Marc