. 2021 Jul 1;22(7):603-615.

doi: 10.1097/PCC.0000000000002760.

Coronavirus Disease 2019-Associated PICU Admissions: A Report From the Society of Critical Care Medicine Discovery Network Viral Infection and Respiratory Illness Universal Study Registry

Sandeep Tripathi¹, Katja M Gist², Erica C Bjornstad³, Rahul Kashyap⁴, Karen Boman⁵, Kathleen Chiotos⁶, Varsha P Gharpure⁷, Heda Dapul⁸, Imran A Sayed², Joshua Kuehne⁹, Julia A Heneghan¹⁰, Manoj Gupta¹¹, Paras B Khandhar¹², Shina Menon¹³, Neha Gupta¹⁴, Vishakha K Kumar⁵, Lynn Retford⁵, Jerry Zimmerman¹³, Utpal S Bhalala¹⁵; Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group

Collaborators, Affiliations

Collaborators

Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group:
Sandeep Tripathi, Tanja Kovacevic, Josko Markic, Tatjana Catipovic Ardalic, Branka Polic, Ivo Ivić, Dominko Carev, Robert Glavinic, Umamaheswara Raju, Janaki Manduva, Naresh Kolakani, Shreeja Sripathi, Sheetal Chaitanya, Sridhar Papani, Mahesh Kamuram, Surapaneni Krishna Mohan, Ekambaram Jyothisree, Yuki Itagaki, Akira Kodate, Reina Suzuki, Akira Kodate, Yuki Takahashi, Koyo Moriki, Muhammad Sohaib Asghar, Mashaal Syed, Syed Anosh Ali Naqvi, Sidra Ishaque, Ali Faisal Saleem, Naveed Ur Rehman Siddiqui, Salima Sherali, Yasmin Hashwani, Shafia Ishaque, Mohammed A Almazyad, Mohammed I Alarifi, Jara M Macarambon, Ahmad Abdullah Bukhari, Hussain A Albahrani, Kazi N Asfina, Kaltham M Aldossary, Varsha P Gharpure, Usman Raheemi, Kenneth W Dodd, Nicholas Goodmanson, Kathleen Hesse, Paige Bird, Chauncey Weinert, Nathan Schoenrade, Abdulrahman Altaher, Esmael Mayar, Matthew Aronson, Tyler Cooper, Monica Logan, Brianna Miner, Gisele Papo, Suzanne Barry, Christopher Woll, Gregory Wu, Erin Carrole, Kathryn Burke, Mustafa Mohammed, Allina Catherine A St Hill, Roman R Melamed, David M Tierney, Love A Patel, Vino S Raj, Barite U Dawud, Narayana Mazumder, Abbey Sidebottom, Alena M Guenther, Benjamin D Krehbiel, Nova J Schmitz, Stacy L Jepsen, Katherine Irby, Ronald C Sanders Jr, Glenda Hefley, Valerie C Danesh, Gueorgui Dubrocq, Amber L Davis, Marissa J Hammers, Jill M McGahey, Amanda C Farris, Elisa Priest, Robyn Korsmo, Lorie Fares, Kathy Skiles, Susan M Shor, Kenya Burns, Corrie A Dowell, Gabriela Hope Gonzales, Melody Flores, Lindsay Newman, Debora A Wilk, Jason Ettlinger, Jaccallene Bomar, Himani Darji, Alejandro Arroliga, Alejandro C Arroliga, Corrie A Dowell, Gabriela Hope Conzales, Melody Flores, Lindsay Newman, Debora A Wilk, Jason Ettlinger, Himani Darji, Jaccallene Bomar, Paras B Khandhar, Elizabeth Kring, Aaron S Miller, Edwin L Anderson, Rosemary Nagy, Ravali R Inja, Grace Arteaga, Emily Levy, Aysun Tekin, Vikas Bansal, Neha N Deo, Mayank Sharma, Romil Singh, Shahraz Qamar, Marija Bogojevic, Ognjen Gajic, Juan Pablo Domecq Garces, Kathleen Chiotos, Allison M Blatz, Giyoung Lee, Ryan H Burnett, Guy I Sydney, Danielle M Traynor, Heda R Dapul, Sourabh Verma, Alan Salas, Ariel Daube, Michelle Korn, Michelle Ramirez, Logi Rajagopalan, Laura Santos, Asher G Bercow, Mark Shlomovich, Melissa Thomas, Sarah Morris, Jennifer Nason, Manoj K Gupta, Franscene E Oulds, Akshay Nandavar, Andy Y Wen, Allie DaCar, Julia A Heneghan, Ronald A Reilkoff, Sarah Eichen, Lexie Goertzen, Scott Rajala, Ghislaine Feussom, Ben Tang, Amy B Christie, Dennis W Ashley, Rajani Adiga, Prithvi Sendi, Meghana Nadiger, Balagangadhar Totapally, Bhagat S Aulakh, Sandeep Tripathi, Jennifer A Bandy, Lisa M Kreps, Dawn R Bollinger, Jennifer A Bandy, Shina Menon, John K McGuire, Deana Rich, Howard A Zaren, Stephanie J Smith, Grant C Lewis, Lauren Seames, Cheryl Farlow, Judy Miller, Gloria Broadstreet, John Lin, Cindy Terrill, Brock Montgomery, Sydney Reyes, Summer Reyes, Alex Plattner, Neha Gupta, Brent R Brown, Tracy L Jones, Kassidy Malone, Lauren A Sinko, Amy B Harrell, Shonda C Ayers, Lisa M Settle, Taylor J Sears, Utpal S Bhalala, Joshua Kuehne, Melinda Garcia, Morgan Beebe, Heather Herrera, Erica C Bjornstad, Nancy M Tofil, Scott House, Isabella Aldana, Casey W Stulce, Grace Chong, Ahmeneh Ghavam, Anoop Mayampurath, Katja M Gist, Imran A Sayed, John Brinton, Larisa Strom, Azra Bihorac, Tezcan Ozrazgat Baslanti, George Omalay, Haleh Hashemighouchani, Julie S Cupka, Matthew M Ruppert, Patrick W McGonagill, Colette Galet, Janice Hubbard, David Wang, Lauren Allan, Aditya Badheka, Madhuradhar Chegondi, Alia Iqbal O'Meara, Ashish K Khanna, Lynne Harris, Bruce Cusson, Jacob Fowler, David Vaneenenaam, Glen McKinney, Imoh Udoh, Kathleen Johnson

Affiliations

¹ Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Illinois, OSF St Francis Medical Centre at Peoria, Peoria, IL.
² Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO.
³ Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
⁴ Department of Anesthesia and Critical Care, Mayo Clinic, Rochester, MN.
⁵ Society of Critical Care Medicine, Mount Prospect, IL.
⁶ Division of Pediatric Critical Care, Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA.
⁷ Division of Pediatric Critical Care. Department of Pediatrics, Advocate Children's Hospital, Park Ridge, IL.
⁸ Division of Pediatric Critical Care, Department of Pediatrics. Hassenfield Children's Hospital at NYU Langone, New York, NY.
⁹ Baylor College of Medicine, Houston, TX.
¹⁰ Division of Pediatric Critical Care, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
¹¹ Division of Pediatric Cardiology, Department of Pediatrics. Lincoln Medical and Mental Health Center, Lincoln Hospital, Bronx, NY.
¹² Division of Pediatric Critical Care, Department of Pediatrics, Beaumont Children's Hospital, Royal Oak, MI.
¹³ Division of Pediatric Nephrology, Department of Pediatrics. Seattle Children's Hospital/University of Washington, Seattle Children's Hospital, Seattle, WA.
¹⁴ Division of Pediatric Critical Care, Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK.
¹⁵ Division of Pediatric Critical Care, Department of Pediatrics, The Children's Hospital of San Antonio, San Antonio and Baylor College of Medicine, Houston, TX.

PMID: 33965987
PMCID: PMC8240492
DOI: 10.1097/PCC.0000000000002760

Coronavirus Disease 2019-Associated PICU Admissions: A Report From the Society of Critical Care Medicine Discovery Network Viral Infection and Respiratory Illness Universal Study Registry

Sandeep Tripathi et al. Pediatr Crit Care Med. 2021.

. 2021 Jul 1;22(7):603-615.

doi: 10.1097/PCC.0000000000002760.

Authors

Collaborators

Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group:
Sandeep Tripathi, Tanja Kovacevic, Josko Markic, Tatjana Catipovic Ardalic, Branka Polic, Ivo Ivić, Dominko Carev, Robert Glavinic, Umamaheswara Raju, Janaki Manduva, Naresh Kolakani, Shreeja Sripathi, Sheetal Chaitanya, Sridhar Papani, Mahesh Kamuram, Surapaneni Krishna Mohan, Ekambaram Jyothisree, Yuki Itagaki, Akira Kodate, Reina Suzuki, Akira Kodate, Yuki Takahashi, Koyo Moriki, Muhammad Sohaib Asghar, Mashaal Syed, Syed Anosh Ali Naqvi, Sidra Ishaque, Ali Faisal Saleem, Naveed Ur Rehman Siddiqui, Salima Sherali, Yasmin Hashwani, Shafia Ishaque, Mohammed A Almazyad, Mohammed I Alarifi, Jara M Macarambon, Ahmad Abdullah Bukhari, Hussain A Albahrani, Kazi N Asfina, Kaltham M Aldossary, Varsha P Gharpure, Usman Raheemi, Kenneth W Dodd, Nicholas Goodmanson, Kathleen Hesse, Paige Bird, Chauncey Weinert, Nathan Schoenrade, Abdulrahman Altaher, Esmael Mayar, Matthew Aronson, Tyler Cooper, Monica Logan, Brianna Miner, Gisele Papo, Suzanne Barry, Christopher Woll, Gregory Wu, Erin Carrole, Kathryn Burke, Mustafa Mohammed, Allina Catherine A St Hill, Roman R Melamed, David M Tierney, Love A Patel, Vino S Raj, Barite U Dawud, Narayana Mazumder, Abbey Sidebottom, Alena M Guenther, Benjamin D Krehbiel, Nova J Schmitz, Stacy L Jepsen, Katherine Irby, Ronald C Sanders Jr, Glenda Hefley, Valerie C Danesh, Gueorgui Dubrocq, Amber L Davis, Marissa J Hammers, Jill M McGahey, Amanda C Farris, Elisa Priest, Robyn Korsmo, Lorie Fares, Kathy Skiles, Susan M Shor, Kenya Burns, Corrie A Dowell, Gabriela Hope Gonzales, Melody Flores, Lindsay Newman, Debora A Wilk, Jason Ettlinger, Jaccallene Bomar, Himani Darji, Alejandro Arroliga, Alejandro C Arroliga, Corrie A Dowell, Gabriela Hope Conzales, Melody Flores, Lindsay Newman, Debora A Wilk, Jason Ettlinger, Himani Darji, Jaccallene Bomar, Paras B Khandhar, Elizabeth Kring, Aaron S Miller, Edwin L Anderson, Rosemary Nagy, Ravali R Inja, Grace Arteaga, Emily Levy, Aysun Tekin, Vikas Bansal, Neha N Deo, Mayank Sharma, Romil Singh, Shahraz Qamar, Marija Bogojevic, Ognjen Gajic, Juan Pablo Domecq Garces, Kathleen Chiotos, Allison M Blatz, Giyoung Lee, Ryan H Burnett, Guy I Sydney, Danielle M Traynor, Heda R Dapul, Sourabh Verma, Alan Salas, Ariel Daube, Michelle Korn, Michelle Ramirez, Logi Rajagopalan, Laura Santos, Asher G Bercow, Mark Shlomovich, Melissa Thomas, Sarah Morris, Jennifer Nason, Manoj K Gupta, Franscene E Oulds, Akshay Nandavar, Andy Y Wen, Allie DaCar, Julia A Heneghan, Ronald A Reilkoff, Sarah Eichen, Lexie Goertzen, Scott Rajala, Ghislaine Feussom, Ben Tang, Amy B Christie, Dennis W Ashley, Rajani Adiga, Prithvi Sendi, Meghana Nadiger, Balagangadhar Totapally, Bhagat S Aulakh, Sandeep Tripathi, Jennifer A Bandy, Lisa M Kreps, Dawn R Bollinger, Jennifer A Bandy, Shina Menon, John K McGuire, Deana Rich, Howard A Zaren, Stephanie J Smith, Grant C Lewis, Lauren Seames, Cheryl Farlow, Judy Miller, Gloria Broadstreet, John Lin, Cindy Terrill, Brock Montgomery, Sydney Reyes, Summer Reyes, Alex Plattner, Neha Gupta, Brent R Brown, Tracy L Jones, Kassidy Malone, Lauren A Sinko, Amy B Harrell, Shonda C Ayers, Lisa M Settle, Taylor J Sears, Utpal S Bhalala, Joshua Kuehne, Melinda Garcia, Morgan Beebe, Heather Herrera, Erica C Bjornstad, Nancy M Tofil, Scott House, Isabella Aldana, Casey W Stulce, Grace Chong, Ahmeneh Ghavam, Anoop Mayampurath, Katja M Gist, Imran A Sayed, John Brinton, Larisa Strom, Azra Bihorac, Tezcan Ozrazgat Baslanti, George Omalay, Haleh Hashemighouchani, Julie S Cupka, Matthew M Ruppert, Patrick W McGonagill, Colette Galet, Janice Hubbard, David Wang, Lauren Allan, Aditya Badheka, Madhuradhar Chegondi, Alia Iqbal O'Meara, Ashish K Khanna, Lynne Harris, Bruce Cusson, Jacob Fowler, David Vaneenenaam, Glen McKinney, Imoh Udoh, Kathleen Johnson

Affiliations

¹ Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Illinois, OSF St Francis Medical Centre at Peoria, Peoria, IL.
² Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO.
³ Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
⁴ Department of Anesthesia and Critical Care, Mayo Clinic, Rochester, MN.
⁵ Society of Critical Care Medicine, Mount Prospect, IL.
⁶ Division of Pediatric Critical Care, Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA.
⁷ Division of Pediatric Critical Care. Department of Pediatrics, Advocate Children's Hospital, Park Ridge, IL.
⁸ Division of Pediatric Critical Care, Department of Pediatrics. Hassenfield Children's Hospital at NYU Langone, New York, NY.
⁹ Baylor College of Medicine, Houston, TX.
¹⁰ Division of Pediatric Critical Care, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
¹¹ Division of Pediatric Cardiology, Department of Pediatrics. Lincoln Medical and Mental Health Center, Lincoln Hospital, Bronx, NY.
¹² Division of Pediatric Critical Care, Department of Pediatrics, Beaumont Children's Hospital, Royal Oak, MI.
¹³ Division of Pediatric Nephrology, Department of Pediatrics. Seattle Children's Hospital/University of Washington, Seattle Children's Hospital, Seattle, WA.
¹⁴ Division of Pediatric Critical Care, Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK.
¹⁵ Division of Pediatric Critical Care, Department of Pediatrics, The Children's Hospital of San Antonio, San Antonio and Baylor College of Medicine, Houston, TX.

PMID: 33965987
PMCID: PMC8240492
DOI: 10.1097/PCC.0000000000002760

Abstract

Objectives: To compare clinical characteristics and outcomes of children admitted to the PICU for severe acute respiratory syndrome coronavirus 2-related illness with or without multisystem inflammatory syndrome in children. The secondary objective was to identify explanatory factors associated with outcome of critical illness defined by a composite index of in-hospital mortality and organ system support requirement.

Design: Retrospective cohort study.

Setting: Thirty-eight PICUs within the Viral Infection and Respiratory Illness Universal Study registry from March 2020 to January 2021.

Patients: Children less than 18 years with severe acute respiratory syndrome coronavirus 2-related illness with or without multisystem inflammatory syndrome in children.

Measurements and main results: Of 394 patients, 171 (43.4%) had multisystem inflammatory syndrome in children. Children with multisystem inflammatory syndrome in children were more likely younger (2-12 yr vs adolescents; p < 0.01), Black (35.6% vs 21.9%; p < 0.01), present with fever/abdominal pain than cough/dyspnea (p < 0.01), and less likely to have comorbidities (33.3% vs 61.9%; p < 0.01) compared with those without multisystem inflammatory syndrome in children. Inflammatory marker levels, use of inotropes/vasopressors, corticosteroids, and anticoagulants were higher in multisystem inflammatory syndrome in children patients (p < 0.01). Overall mortality was 3.8% (15/394), with no difference in the two groups. Diagnosis of multisystem inflammatory syndrome in children was associated with longer duration of hospitalization as compared to nonmultisystem inflammatory syndrome in children (7.5 d[interquartile range, 5-11] vs 5.3 d [interquartile range, 3-11 d]; p < 0.01). Critical illness occurred in 164 patients (41.6%) and was more common in patients with multisystem inflammatory syndrome in children compared with those without (55.6% vs 30.9%; p < 0.01). Multivariable analysis failed to show an association between critical illness and age, race, sex, greater than or equal to three signs and symptoms, or greater than or equal to two comorbidities among the multisystem inflammatory syndrome in children cohort. Among nonmultisystem inflammatory syndrome in children patients, the presence of greater than or equal to two comorbidities was associated with greater odds of critical illness (odds ratio 2.95 [95% CI, 1.61-5.40]; p < 0.01).

Conclusions: This study delineates significant clinically relevant differences in presentation, explanatory factors, and outcomes among children admitted to PICU with severe acute respiratory syndrome coronavirus 2-related illness stratified by multisystem inflammatory syndrome in children.

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Conflict of interest statement

Dr. Bjornstad’s institution received funding from the International Society of Nephrology and Bioporto. Drs. Kashyap’s, Ms. Boman’s, Dr. Kumar’s institutions received funding from The Gordon and Betty Moore Foundation. Drs. Kashyap’s, Ms. Boman’s, and Dr. Kumar’s institutions received funding from Janssen and Janssen LLC. Dr. Kashyap receives funding from the National Institutes of Health (NIH)/National Heart, Lung and Blood Institute: R01HL 130881, UG3/UH3HL 141722; Gordon and Betty Moore Foundation Janssen Research and Development, LLC; and royalties from Ambient Clinical Analytics. Inc. Dr. Chiotos funded by Agency for Healthcare Research and Quality (K12-HS026393). Dr. Heneghan’s institution received funding from Society of Critical Care Medicine (SCCM). Dr Zimmerman’s institution received funding from the NIH, Immunexpress, Seattle, and he received funding from Elsevier Publishing Company. Dr. Kumar receives funding from the Gordon and Betty Moore Foundation, Centers for Disease Control and Prevention Foundation through the University of Washington, and Janssen Research and Development, LLC. Dr. Bhalala currently funded by NIH (site-principal investigator [PI] for Stress Hydrocortisone in Pediatric Septic Shock—R01HD096901), The Children’s Hospital of Philadelphia (site-PI for Pediatric Resuscitation Quality Collaborative), Voelcker Pilot Grant (PI for a project on prearrest electrocardiographic changes), The Children’s Hospital of San Antonio Endowed Chair Funds for ancillary projects related to SCCM Viral Infection and Respiratory Illness Universal Study (VIRUS) (coronavirus disease 2019) Registry and SCCM VIRUS electronic medical record automation pilot. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

**Figure 1.**
Patient recruitment consort diagram. MIS-C = multisystem inflammatory syndrome in children, VIRUS = Viral Infection and Respiratory Illness Universal Study.

**Figure 2.**
Multivariable logistic regression to assess independent explanatory factors associated with the critical illness among those with multisystem inflammatory syndrome in children (MIS-C) (A) and non-MIS-C (B) patients. Race category combined to three (Black, White, and Others). For logistic regression, patients with race listed as unknown (n = 20; 5% of the total cohort) were included in the “Other” category. Adolescent greater than or equal to 12 yr. ^*In different organ systems. Organ system categorization for signs and symptoms and a complete list of comorbidities listed in the SDC (http://links.lww.com/PCC/B784).

See this image and copyright information in PMC

References

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Coronavirus Disease 2019-Associated PICU Admissions: A Report From the Society of Critical Care Medicine Discovery Network Viral Infection and Respiratory Illness Universal Study Registry

Collaborators

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Coronavirus Disease 2019-Associated PICU Admissions: A Report From the Society of Critical Care Medicine Discovery Network Viral Infection and Respiratory Illness Universal Study Registry

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Abstract

Conflict of interest statement

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