Paediatric critical COVID-19 and mortality in a multinational prospective cohort
Sebastián González‐Dambrauskas, Pablo Vásquez‐Hoyos, Anna Camporesi, Edwin Mauricio Cantillano, Samantha Dallefeld, Jesús Domínguez-Rojas, Conall Francoeur, Anar Gurbanov, Liliana Mazzillo Vega, Steven L. Shein, Adriana Yock‐Corrales, Todd Karsies, Ryan A. Nofziger, Shashikanth Ambati, Tanıl Kendirli, Ronald C. Sanders, Lee Polikoff, Siobhan Whelan, Anna Camporesi, Conall Francoeur, Francisca Castro, Claudia Beltrán-Arroyave, Rosalba Pardo, Gonzalo Vega, Mauricio Yunge, Lorena Acevedo, Ivan Jose Ardila, Diego Aránguiz, Samantha Dallefeld, Martha I. Álvarez-Olmos, Jaime Fernández‐Sarmiento, Arieth Figueroa-Vargas, Maribel Valencia-Benavides, Juan D. Roa, Rubén Eduardo Lasso Palomino, Alessia Franceschi, Carina Venthur, Sebastián González‐Dambrauskas, Camila Ampuero, Jhovana E. Paco-Barral, Jaime Tasayco-Muñoz, Jesús Domínguez-Rojas, Francisca Rafael-Patricio, Solana Pellegrini, Marcela Zuazaga, Silvana Brusca, M. A. Hernández Viera, Vladmir Ivan Aguilera-Avendano, Franklin Alejandro, L. Martínez, E. Thelma, María Eugenia Terán, Mariela Coronado-Lujan, Fabiola Castro-Mancilla, Franco Díaz, Karina Cinquegrana, Alicia Sandoval, Andrea González, Marta Zamora, Yúrika López-Alarcón, María Slöcker-Barrio, Javier Urbano-Villaescusa, Humberto Camacho, Liliana Mazzillo, Beatriz F. Giraldo, Pitas Suarez, M. Céspedes-Lesczinsky, Jorge Omar Castillo, Juan Pablo Fabris, Carolina Paladino, Silvia Sanabria, Erika Urena-Chavarría, Adriana Yock‐Corrales, Gaudi Quispe, Manuel Eduardo Munaico Abanto, Miriam Giovanna Colombo, Ana Carola Blanco, Byron Enrique Piñeres-Olave, Ricardo Carvajal-Veas, Patrícia Correa, Ricardo Garcia-De-Jesus, Arani Ferre, P. Pietroboni, Edwin Mauricio-Cantillano, Linda Banegas-Pineda, Nils Casson-Rodriguez, Agustín Cavagnaro, Adriana Wegner, Eliana Zemanate, Emilce Beltran-Zuñiga, María Alejandra Suarez, Deyanira Quiñonez, Leonardo Valero, Alejandra Repetur, Pablo Castellani, Adriana Bordogna, Alfredo De-la-Hoz-Pastor, Evelyn Obando-Belalcazar, Andrew Prout, Roberto Jabornisky
Abstract
Background: To understand critical paediatric coronavirus disease 2019 (COVID-19) and evaluate factors associated with mortality in children from high and low-middle income countries. Methods: Prospective, observational study of critically ill children hospitalised for COVID-19 in 18 countries throughout North America, Latin America, and Europe between April 1 and December 31, 2020. Associations with mortality were evaluated using logistic regression. Findings: 557 patients (median age, 8 years; 24% <2 years) were enrolled from 55 sites (63% Latin American). Half had comorbidities. Invasive (41%) or non-invasive (20%) ventilation and vasopressors (56%) were the most common support modalities. Hospital mortality was 10% and higher in children <2 years old (15%; odds ratio 1·94, 95%CI 1·08-3·49). Most who died had pulmonary disease. When adjusted for age, sex, region, and illness severity, mortality-associated factors included cardiac (aOR 2·89; 95%CI 1·2-6·94) or pulmonary comorbidities (aOR 4·43; 95%CI 1·70-11·5), admission hypoxemia (aOR 2·44; 95%CI 1·30-4·57), and lower respiratory symptoms (aOR 2·96; 95%CI 1·57-5·59). MIS-C (aOR 0·25; 95%CI 0·1-0·61) and receiving methylprednisolone (aOR 0·5; 95%CI 0·25-0·99), IVIG (aOR 0·32; 95%CI 0·16-0·62), or anticoagulation (aOR 0·49; 95%CI 0·25-0·95) were associated with lower mortality although these associations might be limited to children >2 years old. Interpretation: We identified factors associated with COVID-19 mortality in critically ill children from both high and low-middle income countries, including higher mortality with younger age and COVID-related pulmonary disease but lower mortality in MIS-C. Further research is needed on optimal treatments for younger children and respiratory failure in paediatric COVID-19. Funding: None.