Comorbidities That Increase Risk for Severe Acute Covid-19 in Pediatric Population

ABSTRACT

Background: Little is understood about which comorbidities are associated with severe outcomes in children hospitalized with acute COVID-19. Some confusion lies especially for cancer or diabetes. Method(s) Data from 2 multicenter prospective cohort studies of hospitalized children (aged 0-18 years) with confirmed SARS-CoV-2 in Spain and Colombia were combined for this analysis. Data were obtained from 116 hospitals. Outcome was classified as (in decreasing order of severity) death, mechanical ventilation (MV), pediatric intensive care unit (PICU) admission, high flow/CPAP, oxygen therapy with nasal prong (NP) and hospitalization without respiratory support. Risk factors for severity, adjusting for age and gender, were identified using multinominal logistic regression and a backwards selection process. Result(s) A total of 1,753 patients were included, 734 (41.8%) in Spain and 1,019 (58.1%) in Colombia. The most frequent comorbidities were asthma (9.0%), chronic neurological disorder (NRL) (7.4%), immunosuppressive medication (7.2%), malignant neoplasms (5.4%) and chronic lung disease (not asthma) (CLD) (4.5%). Comorbidities associated with the different endpoints are summarized in Figure 1. Asthma was associated with a significantly increased risk of death (OR 4.17;95%CI 1.34-12.97), MV (OR 7.94 (3.59-17.56)), PICU admission (OR 3.37 (1.91- 5.96)), high flow/CPAP (OR 6.65 (2.69-16.46)), and NP (OR 3.85 (2.57-5.77)) compared to hospitalization without respiratory support. NRL was associated with increased risk of death (OR 7.34 (3.01-17.90)), MV (OR 3.07 (1.20-7.82)) and high flow/CPAP (OR 4.36 (1.68-11.29)). CLD was associated with increased risk of death (OR 6.22 [2.28-16.94]) and NP (OR 3.1 (1.74-5.58)) and in addition, chronic cardiac disease was associated with increased risk of MV (OR 5.21 (1.76-15.41)) and PICU (OR 2.78 (1.27-6.08)). Risks of death (OR 4.49 (2.03-9.05)), MV (OR 2.97 (1.52-5.81)), PICU (OR 4.27 (2.89-6.33)), and NP (OR 4.67 (3.64-5.99)) were higher in the Colombia Cohort. Conclusion(s) Asthma, chronic neurological, cardiac and lung disease;and belonging to the Colombia cohort were consistently associated with multiple severe outcomes of COVID-19. Cancer and diabetes association with selected endpoints rather than with most endpoints may be more related to the baseline disease than with the actual COVID-19.