ABSTRACT
BackgroundThe significant variations in clinical characteristics and outcomes of COVID-19 that range from asymptomatic to severe fatal illness entail searching for potential prognostic determinants to help predict the disease course and early detection of patients at risk of developing life-threatening complications. Although children are less commonly infected by SARS-CoV-2 than their adult counterparts, and their symptoms are generally milder, a severe type of COVID-19 cannot be precluded. MethodsAt first, demographic, clinical, laboratory measurement data, and outcomes for 26 COVID-19 infected children of less than 12 years of age, admitted to King Abdallah Hospital, Bisha, Saudi Arabia, were retrieved from the electronic medical records for the observational retrospective study. Later, electronic and manual database searches were carried out for pediatric severe COVID-19-related articles. The relevant data from 20 eligible studies and the present retrospective study were analyzed to assess the association of demographic characteristics and comorbidities with COVID-19 severity. ResultsIn the retrospective study, 5 (19%) of the children presented with severe symptoms admitted to PICU, 18 (69%) presented with cough, 5 (19%) with diarrhea, 7 (27%) with underlying comorbidities, 4 (15%) with respiratory illnesses, 3 (12%) with cardiovascular diseases and 2 (8%) were obese. None of the patient characteristics showed any significant association with COVID-19 severity. Of the 21 studies selected for meta-analyses, 14 studies were included in the analysis of the association between any comorbidity and disease severity, resulting in OR: 2.69, 95%CI: 1.38 - 5.26, P < 0.05, for analysis of the association between cardiovascular comorbidities and disease severity 14 studies were included giving OR: 4.06, 95%CI: 1.86 - 8.87, P < 0.05, for analysis of the association between respiratory comorbidity and disease severity 15 studies were included giving OR: 2.05, 95%CI: 1.54 - 2.74, P < 0.05, for analysis of the association between obesity and disease severity 10 studies were included, giving OR: 2.48, 95%CI: 1.16 - 5.32, P < 0.05, for analysis of the association between age <10 years old and diseases severity, 16 studies were included, giving OR: 0.80, 95%CI: 0.65 - 0.97, P < 0.05, and for analysis of the association between female gender and disease severity, 19 studies were included, giving OR: 0.83, 95%CI: 0.59 - 1.18, P > 0.05. ConclusionIt can be concluded that COVID-19 pediatric patients with underlying comorbidities, being cardiovascular, respiratory, or obesity, are at high risk of developing severe illness, and young age has a protective role against the disease severity.