Characteristics and risk factors associated with critical illness in pediatric COVID-19

ABSTRACT

INTRODUCTION: Little is known regarding the course and severity of pediatric COVID-19. We describe critical illness in pediatric patients with PCR+ SARS-CoV2 infection and identify factors associated with PICU admission and organ dysfunction. METHODS: This is a retrospective chart review of 77 pediatric patients age 1 day to 21 years admitted to two New York City pediatric hospitals within the Northwell Health system between February 1 and April 24, 2020 with PCR+ SARS-CoV-2. Descriptive statistics were used to describe the hospital course and laboratory results and bivariate comparisons were performed on variables to determine differences. RESULTS: Forty-seven patients (61%) were admitted to the general pediatric floor and thirty (39%) to the PICU. The majority (97%, n=68) survived to discharge, 1.3% (n=1) remain admitted, and one (1.3%) died. Of PICU patients, 46.7% experienced significant organ dysfunction (pSOFA>=2) during admission. Patients aged 12 years or greater were more likely to be admitted to a PICU compared to younger patients (p=0.015). Presence of an underlying comorbidity was not associated with need for PICU admission (p=0.23) or organ dysfunction (p=0.87). Initial white blood cell count (WBC), platelet count, and ferritin were not associated with need for PICU admission. Initial C-reactive protein was associated with both need for PICU admission (p=0.005) and presence of organ dysfunction (p=0.001). Initial WBC was associated with organ dysfunction (p=0.034). Presenting thrombocytopenia was associated with organ dysfunction (p=0.003). Common indications for PICU admission included hypoxia (50%), hemodynamic instability (20%), diabetic ketoacidosis (6.7%), mediastinal mass (6.7%), apnea (6.7%), acute chest syndrome (6.7%), and cardiac dysfunction (6.7%). CONCLUSIONS: Need for PICU admission in COVID-19 was associated with age over 12 years and elevated initial CRP. Organ dysfunction was associated with elevated admission CRP and WBC and decreased platelet count. These factors may be useful in determining risk for critical illness and organ dysfunction in pediatric COVID-19.