ABSTRACT
COVID-19 affects children less seriously than adults; however, severe cases and deaths are documented. This study objective is to determine socio-demographic, clinical and laboratory indicators associated with severe pediatric COVID-19 and mortality at hospital entrance. A multicenter, retrospective, cross-sectional study was performed in 13 tertiary hospitals in Bolivia. Clinical records were collected retrospectively from patients less than 18 years of age and positive for SARS-CoV-2 infection. All variables were measured at hospital entrance; outcomes of interest were ICU admission and death. A score for disease severity was developed using a logistic regression model. 209 patients were included in the analysis. By the end of the study, 43 (20.6%) of children were admitted to the Intensive care unit (ICU), and 17 (8.1%) died. Five indicators were independently predictive of COVID-19 severity: age below 10 years OR: 3.3 (CI95%: 1.1-10.4), days with symptoms to medical care OR: 2.8 (CI95%: 1.2-6.5), breathing difficulty OR: 3.4 (CI95%: 1.4-8.2), vomiting OR: 3.3 (CI95%: 1.4-7.4), cutaneous lesions OR: 5.6 (CI95%: 1.9-16.6). Presence of three or more of these risk factors at hospital entrance predicted severe disease in COVID-19 positive children. Age, presence of underlying illness, male sex, breathing difficulty, and dehydration were predictive of death in COVID-19 children. Our study identifies several predictors of severe pediatric COVID-19 and death. Incorporating these predictors, we developed a tool that clinicians can use to identify children at high risk of severe COVID-19 in limited-resource settings.
Subject(s)
COVID-19 , SARS-CoV-2 , Severity of Illness Index , Humans , COVID-19/mortality , COVID-19/epidemiology , COVID-19/diagnosis , Child , Male , Female , Child, Preschool , Adolescent , Retrospective Studies , Cross-Sectional Studies , Infant , SARS-CoV-2/isolation & purification , Bolivia/epidemiology , Hospitalization , Intensive Care Units/statistics & numerical data , Risk Factors , Sociodemographic FactorsABSTRACT
La enfermedad de Addison resulta de la destrucción progresiva de las glándulas adrenales pudiendo llegar a destruir hasta el 90% antes de que aparezca una insuficiencia corticosuprarrenal clínicamente observable. Históricamente, la tuberculosis fue una causa frecuente de la enfermedad de Addison, aunque otras enfermedades también pueden producir la enfermedad. La enfermedad de Addison estima una prevalencia de aproximadamente 110 casos por millón de habitantes y una incidencia de 5 a 6 casos por millón al año. Presentamos el caso clínico de un paciente de sexo masculino que ingresa al servicio de infectología del hospital Clínico Viedma, con el antecedente de cambio de coloración de la piel en miembros de cinco meses de evolución, cuadro se acompaño de disnea de clase III. En el examen físico general se observó hiperpigmentación generalizada que compromete mucosas, signos vitales normales. Al examen físico regional presentó adinamia, anorexia y astenia.
Addison's disease results because of the progressive destruction of the adrenal glands that reach up to 90% destroyed before appears clinical evidence ot adrenal insufficiency. Historically, tuberculosis was a common cause of Addison's disease, but other diseases can also cause the disease. Moreover, Addison's disease estimated prevalence is approximately 110 cases per million habitants and an incidence of five to six cases per million per year. We report a case of a male patient admitted in the Infectious Disease Clinical Hospital Viedma, with the history of change in skin coloration members, five months history painting was accompanied by dyspnea class III. In the physical examination was observed committing widespread mucosal hyperpigmentation, normal vital signs. Physical examination showed regional weakness, anorexia and asthenia.
