ABSTRACT
Purpose: SARS-CoV-2 infection in children is usually asymptomatic/mild. However, some patients may develop critical forms. Our aim was to evaluate the independent risk factors associated to in-hospital mortality in children with critical disease related to SARS-CoV-2. Methods: This is multicenter prospective cohort included critically ill children (1 month/18 years of age), with confirmed critical disease related to SARS-CoV-2 admitted to three tertiary Pediatric Intensive Care Units (PICU) in Brazilian Amazon, between April 2020/July 2022. Main outcome was in-hospital mortality. The independent risk factors associated with mortality were evaluated with a multivariable Cox proportional regression. Results: 208 patients were assessed. Median age was 33 months and median follow-up was 277 days (range, 2-759). Death occurred in 37 (17.8%) patients with a median follow-up of 7 (4-13) days. Most non-survivors had at least one comorbidity - 34 (91.9%). Substantial clinical features, laboratory and ventilatory parameters were associated with mortality. Independent risk factors for mortality were underweight status (HR= 6.64, p=0.01), vasoactive inotropic score (VIS) > 84 (HR=4.76, p=0.05), acute respiratory distress syndrome (HR=8.63, p=0.02) and erythrocyte sedimentation rate (ESR) >18 mm/hour (HR=3.95, p=0.03). Conclusions: This study of critically ill patients with COVID-19 and MIS-C from the Brazilian Amazon showed a high mortality rate. The risk of death was higher for underweight individuals, those with higher levels of VIS and ESR, presence of ARDS. The majority of deaths occurred within 10 days of hospitalization, highlighting the importance of prompt recognition in regard to these patients.