Risk factors for poor prognosis in children and adolescents with COVID-19: A systematic review and meta-analysis
Qianling Shi, Zijun Wang, Jiao Liu, Xingmei Wang, Qi Zhou, Qinyuan Li, Yu Yang, Zhengxiu Luo, Enmei Liu, Yaolong Chen
Abstract
Background: This study provides the first systematic review and meta-analysis to identify the predictors of unfavorable prognosis of COVID-19 in children and adolescents. Methods: We searched literature databases until July 2021 for studies that investigated risk factors for unfavorable prognosis of children and adolescents with COVID-19. We used random-effects models to estimate the effect size with 95% confidence interval (CI). Findings: We identified 56 studies comprising 79,104 individuals. Mortality was higher in patients with multisystem inflammatory syndrome (MIS-C) (odds ratio [OR]=58.00, 95% CI 6.39526.79) and who were admitted to intensive care (OR=12.64, 95% CI 3.4246.68). Acute respiratry distress syndrme (ARDS) (OR=29.54, 95% CI 12.6968.78) and acute kidney injury (AKI) (OR=55.02, 95% CI 6.26483.35) increased the odds to be admitted to intensive care; shortness of breath (OR=16.96, 95% CI 7.6637.51) increased the need of respiratory support; and neurological diseases (OR=5.16, 95% CI 2.3011.60), C-reactive protein (CRP) level 80 mg/ L (OR=11.70, 95% CI 4.3731.37) and D-dimer level 0.5ug/mL (OR=20.40, 95% CI 1.76236.44) increased the odds of progression to severe or critical disease.