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. 2022 Feb 3;59(2):2101341.
doi: 10.1183/13993003.01341-2021. Print 2022 Feb.

Risk factors for post-COVID-19 condition in previously hospitalised children using the ISARIC Global follow-up protocol: a prospective cohort study

Ismail M Osmanov  1   2   3 , Ekaterina Spiridonova  4   3 , Polina Bobkova  4   3 , Aysylu Gamirova  4   3 , Anastasia Shikhaleva  4   3 , Margarita Andreeva  4   3 , Oleg Blyuss  4   5   3 , Yasmin El-Taravi  4 , Audrey DunnGalvin  4   6 , Pasquale Comberiati  7 , Diego G Peroni  7 , Christian Apfelbacher  8 , Jon Genuneit  9 , Lyudmila Mazankova  10 , Alexandra Miroshina  1 , Evgeniya Chistyakova  11 , Elmira Samitova  1   10 , Svetlana Borzakova  2   12 , Elena Bondarenko  4 , Anatoliy A Korsunskiy  4 , Irina Konova  1 , Sarah Wulf Hanson  13 , Gail Carson  14 , Louise Sigfrid  14 , Janet T Scott  15 , Matthew Greenhawt  16 , Elizabeth A Whittaker  17 , Elena Garralda  18 , Olivia V Swann  19   20 , Danilo Buonsenso  21   22   23 , Dasha E Nicholls  18 , Frances Simpson  24 , Christina Jones  25 , Malcolm G Semple  26   27 , John O Warner  28 , Theo Vos  13 , Piero Olliaro  14 , Daniel Munblit  29   28   30   3 ; and the Sechenov StopCOVID Research Team
Affiliations

Risk factors for post-COVID-19 condition in previously hospitalised children using the ISARIC Global follow-up protocol: a prospective cohort study

Ismail M Osmanov et al. Eur Respir J. .

Abstract

Background: The long-term sequelae of coronavirus disease 2019 (COVID-19) in children remain poorly characterised. This study aimed to assess long-term outcomes in children previously hospitalised with COVID-19 and associated risk factors.

Methods: This is a prospective cohort study of children (≤18 years old) admitted to hospital with confirmed COVID-19. Children admitted between 2 April 2020 and 26 August 2020 were included. Telephone interviews used the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 Health and Wellbeing Follow-up Survey for Children. Persistent symptoms (>5 months) were further categorised by system(s) involved.

Results: 518 out of 853 (61%) eligible children were available for the follow-up assessment and included in the study. Median (interquartile range (IQR)) age was 10.4 (3-15.2) years and 270 (52.1%) were girls. Median (IQR) follow-up since hospital discharge was 256 (223-271) days. At the time of the follow-up interview 126 (24.3%) participants reported persistent symptoms, among which fatigue (53, 10.7%), sleep disturbance (36, 6.9%) and sensory problems (29, 5.6%) were the most common. Multiple symptoms were experienced by 44 (8.4%) participants. Risk factors for persistent symptoms were: older age "6-11 years" (OR 2.74, 95% CI 1.37-5.75) and "12-18 years" (OR 2.68, 95% CI 1.41-5.4), and a history of allergic diseases (OR 1.67, 95% CI 1.04-2.67).

Conclusions: A quarter of children experienced persistent symptoms months after hospitalisation with acute COVID-19 infection, with almost one in 10 experiencing multisystem involvement. Older age and allergic diseases were associated with higher risk of persistent symptoms at follow-up.

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Conflict of interest statement

Conflict of interest: J. Genuneit reports working as a project manager of unrestricted research grants on the composition of breast milk to Ulm University and Leipzig University with funding from Danone Nutricia Research. M.G. Semple reports grants from the Dept of Health and Social Care National Institute of Health Research UK, grants from the Medical Research Council UK, grants from the Health Protection Research Unit in Emerging & Zoonotic Infections, University of Liverpool, outside the submitted work; he also reports a minority ownership at Integrum Scientific LLC (Greensboro, NC, USA), outside the submitted work. T. Vos reports personal fees for work on the Global Burden of Disease Study from the Bill and Melinda Gates Foundation, outside the submitted work. C. Apfelbacher has received lecture fees from AstraZeneca, and is a member of a group developing a core outcome set for long COVID, outside the submitted work. All other authors report no relevant conflict of interests.

Figures

FIGURE 1
FIGURE 1
Flow diagram of patients with COVID-19 admitted to Z.A. Bashlyaeva Children's Municipal Clinical Hospital between 2 April 2020 and 26 August 2020. #: relatives unable to describe the child's health; relatives not willing to refer interviewers to the child's parents/carers; inability to speak Russian.
FIGURE 2
FIGURE 2
Duration of the most common symptoms (post-discharge) in children who experienced symptoms at the time of discharge. The calculations are based on responses to the questions: “Within the last seven days, has your child had any of these symptoms, which were NOT present prior to their Covid-19 illness? (If yes, please indicate below and the duration of the symptom/s)” and “Please report any symptoms that have been bothering your child since discharge that are not present today. Please specify the time of onset and duration of these symptoms”.
FIGURE 3
FIGURE 3
UpSet plot representing the coexistence of persistent symptom (present at the time of follow-up interview and lasting for >5 months) categories at follow-up assessment. The values represent the number of individuals experiencing a persistent symptom category or combination of categories. Dark blue lines link multiple symptoms indicated by dark blue circles.
FIGURE 4
FIGURE 4
Multivariable logistic regression model to identify pre-existing risk factors for long COVID. Odds ratios (with 95% confidence intervals) for the presence of a) any category of persistent symptoms (n=127) at the time of follow-up and b) two or more coexisting categories of persistent symptoms (n=73) at the time of follow-up. Neurological conditions and allergic diseases are specified in table 1. Odds ratios are plotted on a log scale.
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