Age as a predictor of COVID-19 severity in pediatric patients: a retrospective cohort study at a referral hospital in Peru
DOI:
https://doi.org/10.35663/amp.2024.413.3063Keywords:
SARS-CoV-2, COVID-19, Child, Patient acuity, PeruAbstract
Objective: To estimate the role of age as a predictor of COVID-19 severity in pediatric patients hospitalized with a COVID-19 diagnosis at a reference hospital in Peru. Materials and methods: A retrospective cohort study was conducted, including pediatric patients from one month old to less than 14 years of age, hospitalized between May 2020 and December 31, 2021, at the Edgardo Rebagliati-Martins National Hospital. The exposure variable was age, categorized in six-month intervals. The outcome variable was the severity of COVID-19, determined according to the severity criteria established in the EsSalud Clinical Practice Guidelines for the management of COVID-19 in pediatrics. Crude and adjusted relative risks (RR) were estimated, with their respective 95% confidence intervals (95% CI). Results: Three-hundred and thirty-one patients were analyzed, their median age was 94 months (7,8 years), and the male-to-female ratio was 1.23. Comorbidities were present in 59.5% of the patients, with neurological disorders being the most common (13.9%). Fatalities were 3.3% of the whole sample, and 63.6% of them were severe cases. Severe COVID-19 was found in 9.4% of the sample. In the adjusted regression model, increasing age was not found to be a predictor of reduced risk of COVID-19 severity (adjusted RR= 1.02; 95% CI 0.98-1.06). Conclusion: Our study did not find age as a predictor of COVID-19 severity in hospitalized pediatric patients. Future studies are recommended to further explore and contrast our findings.
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1. Taylor EH, Marson EJ, Elhadi M, Macleod KDM, Yu YC, Davids R, et al. Factors associated with mortality in patients with COVID-19 admitted to intensive care: a systematic review and meta-analysis. Anaesthesia . 2021 29;76(9):1224-32. doi: 10.1111/anae.15532.
2. Chang TH, Wu JL, Chang LY. Clinical characteristics and diagnostic challenges of pediatric COVID-19: A systematic review and metaanalysis. J Formos Med Assoc . 2020;119(5):982-9. doi: 10.1016/j.jfma.2020.04.007.
3. Wang JG, Zhong ZJ, Mo YF, Wang LC, Chen R. Epidemiological features of coronavirus disease 2019 in children: a meta-analysis. Eur Rev Med Pharmacol Sci. 2021;25(2):1146-1157. doi: 10.26355/eurrev_202101_24685.
4. La Fauci G, Montalti M, Di Valerio Z, Gori D, Salomoni MG, Salussolia A, et al. Obesity and COVID-19 in Children and Adolescents: Reciprocal Detrimental Influence. Systematic Literature Review and Meta-Analysis. Int J Environ Res Public Health. 2022;19(13):1-15. doi: 10.3390/ijerph19137603.
5. Götzinger F, Santiago-García B, Noguera-Julián A, Lanaspa M, Lancella L, Calò Carducci FI, et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health. 2020;4(9):653-661. doi: 10.1016/S2352-4642(20)30177-2.
6. Tsankov BK, Allaire JM, Irvine MA, Lopez AA, Sauvé LJ, Vallance BA, et al. Severe COVID-19 Infection and Pediatric Comorbidities: A Systematic Review and Meta-Analysis. Int J Infect Dis . 2021;103:246-56. doi: 10.1016/j.ijid.2020.11.163.
7. Castro-Rodriguez JA, Forno E. Asthma and COVID-19 in children: A systematic review and call for data. Pediatr Pulmonol. 2020;55(9):2412-8. doi: 10.1002/ppul.24909.
8. Choi JH, Choi S-H, Yun KW. Risk Factors for Severe COVID-19 in Children: A Systematic Review and Meta-Analysis. J Korean Med Sci. 2022;37(5):1-14. doi: 10.3346/jkms.2022.37.e35.
9. Harwood R, Yan H, Talawila Da Camara N, Smith C, Ward J, Tudur-Smith C, et al. Which children and young people are at higher risk of severe disease and death after hospitalisation with SARS-CoV-2 infection in children and young people: A systematic review and individual patient meta-analysis. EClinicalMedicine. 2022;44:101287. doi: 10.1016/j.eclinm.2022.101287.
10. Domínguez Rojas J, Estupiñan Vigil M, Garcés-Ghilardi R, Alvarado-Gamarra G, del Águila O, Lope Tenorio AF, et al. Cross-sectional study of the clinical characteristics and outcomes of children hospitalized with COVID-19 in Lima, Peru. Medwave . 2021;23;21(01):e8107-e8107. doi: 10.5867/medwave.2021.01.8107.
11. Filgueira F, Galindo LM, Giambruno C, Blofield M. América Latina ante la crisis del COVID-19: vulnerabilidad socioeconómica y respuesta social. Políticas Soc . 2020;238:90. Available from: https://repositorio.cepal.org/bitstream/handle/11362/46484/1/S2000718_es.pdf
12. Gonzales GF. ¿Es Perú el país con mayor tasa de mortalidad en el mundo?: un análisis situacional. Rev la Soc Peru Med Interna. 2022;22;35(4):e701. doi: 10.36393/spmi.v35i4.701.
13. Ministerio de Salud Perú. Sala situacional COVID -19 Perú [Internet]. Lima: Minsa; 2022 [citado el 23 de setiembre de 2023]. Disponible en: https://www.dge.gob.pe/portalnuevo/salas-situacionales/enfermedades-transmisibles/covid-19/situacion-del-covid-19-enel-peru/
14. Oblitas Gonzales A, Herrera Ortiz JU, Hernández Williams R, Asenjo Alarcón JA, Sánchez Delgado A. Caracterización de niños diagnosticados con COVID-19 en una provincia de la sierra norte del Perú. Rev Cubana Pediatr. 2021;93(3):1-18.
15. Pereira-Victorio CJ, Saldivar-tapia TL, Valladares-garrido MJ. Coberturas de vacunación en tiempos de COVID-19: Un análisis desde la epidemiología social en la región del Cusco. Rev Cuerpo Med HNAAA. 2024;13(2):167-74. doi: 10.35434/rcmhnaaa.2020.132.668.
16. Dammert AC. Acceso a servicios de salud y mortalidad infantil en el Perú. Lima: Consorc Investig Económica y Soc/Grup Análisis para el Desarro; 2001.
17. Nakanishi T, Pigazzini S, Degenhardt F, Cordioli M, Butler-Laporte G, Maya-Miles D, et al. Age-dependent impact of the major common genetic risk factor for COVID-19 on severity and mortality. J Clin Invest . 2021 ;131(23):1-13. doi: 10.1172/JCI152386.
18. Instituto de Evaluación de Tecnologías en Salud e Investigación. Guía de práctica Clínica para el manejo de COVID-19 en Pediatría. Lima: EsSalud; 2022 [citado el 30 de octubre de 2023]. Disponible en: https://ietsi.essalud.gob.pe/wp-content/uploads/2022/01/GPC-COVID-19-en-pediatria_Version-extensa-y-anexos.pdf
19. Mark EG, Golden WC, Gilmore MM, Sick-Samuels A, Curless MS, Nogee LM, et al. Community-Onset Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Young Infants: A Systematic Review. J Pediatr. 2021;228:94-100.e3. doi: 10.1016/j.jpeds.2020.09.008.
20. Farrar DS, Drouin O, Moore Hepburn C, Baerg K, Chan K, Cyr C, et al. Risk factors for severe COVID-19 in hospitalized children in Canada: A national prospective study from March 2020–May 2021. Lancet Reg Health Am. 2022;15:100337. doi: 10.1016/j.lana.2022.100337.
21. Jarovsky D, de Freitas Fongaro G, Zampol RM, de Oliveira TA, Farias CGA, da Silva DGBP, et al. Characteristics and clinical outcomes of COVID-19 in children: a hospital-based surveillance study in Latin America’s hardest-hit city. IJID Reg. 2023;7:52-62. doi: 10.1016/j.ijregi.2022.12.003.
22. Ortiz-Prado E, Izquierdo-Condoy JS, Fernandez-Naranjo R, Vasconez J, Dávila Rosero MG, Revelo-Bastidas D, et al. The deadly impact of COVID-19 among children from Latin America: The case of Ecuador. Front Pediatr. 2023;11:1-12. doi: 10.3389/fped.2023.1060311.
23. Badal S, Thapa Bajgain K, Badal S, Thapa R, Bajgain BB, Santana MJ. Prevalence, clinical characteristics, and outcomes of pediatric COVID-19: A systematic review and meta-analysis. J Clin Virol. 2021;135:104715. doi: 10.1016/j.jcv.2020.104715.
24. Gaythorpe KAM, Bhatia S, Mangal T, Unwin HJT, Imai N, CuomoDannenburg G, et al. Children’s role in the COVID-19 pandemic: a systematic review of early surveillance data on susceptibility, severity, and transmissibility. Sci Rep. 2021;11(1):1-14. doi: 10.1038/s41598-021-97183-w.
25. Coronado Munoz A, Tasayco J, Morales W, Moreno L, Zorrilla D, Stapleton A, et al. High incidence of stroke and mortality in pediatric critical care patients with COVID-19 in Peru. Pediatr Res. 2022;3;91(7):1730-4. doi: 10.1038/s41390-021-01547-x.
26. Hoste L, Paemel R Van, Haerynck F. Multisystem inflammatory syndrome in children related to COVID-19: a systematic review. Eur J Pediatr. 2021;180(7):2019-2034. doi: 10.1007/s00431-021-03993-5.
27. Fernández JRH. Impacto económico y social de la COVID-19 en el Perú. Revista de Ciencia e Investigación en Defensa. 2021;2(1):31-42. doi: 10.58211/recide.v2i1.51.
28. Kollmann TR, Kampmann B, Mazmanian SK, Marchant A, Levy O. Protecting the Newborn and Young Infant from Infectious Diseases: Lessons from Immune Ontogeny. Immunity. 2017;46(3):350-63. doi: 10.1016/j.immuni.2017.03.009.
29. Kollmann TR, Crabtree J, Rein-Weston A, Blimkie D, Thommai F, Wang XY, et al. Neonatal Innate TLR-Mediated Responses Are Distinct from Those of Adults. J Immunol. 2009;183(11):7150-60. doi: 10.4049/jimmunol.0901481.
30. Williams N, Radia T, Harman K, Agrawal P, Cook J, Gupta A. COVID-19 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review of critically unwell children and the association with underlying comorbidities. Eur J Pediatr. 2021 10;180(3):689-97. doi: 10.1007/s00431-020-03801-6.
31. Zeng Z, Yu H, Chen H, Qi W, Chen L, Chen G, et al. Longitudinal changes of inflammatory parameters and their correlation with disease severity and outcomes in patients with COVID-19 from Wuhan, China. Crit Care. 2020;27;24(1):525. doi: 10.1186/s13054-020-03255-0.
32. Malik P, Patel U, Mehta D, Patel N, Kelkar R, Akrmah M, et al. Biomarkers and outcomes of COVID-19 hospitalisations: systematic review and meta-analysis. BMJ Evidence-Based Med. 2021;26(3):107-8. doi: 10.1136/bmjebm-2020-111536.
33. Melo AKG, Milby KM, Caparroz ALMA, Pinto ACPN, Santos RRP, Rocha AP, et al. Biomarkers of cytokine storm as red flags for severe and fatal COVID-19 cases: A living systematic review and meta-analysis. PLoS One. 2021;29;16(6):e0253894. doi: 10.1371/journal.pone.0253894.
34. El-Khaiat MM, El-lehlah AM, Kesheita MA, Abdel-Samiee M, Teima AAA. Association between thrombocytopenia and the severity of Covid-19 infection among hospitalized Egyptian patients. Ann Med Surg . 2022;79:103973. doi: 10.1016/j.amsu.2022.103973.
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