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. 2023 Oct 18:11:1260372.
doi: 10.3389/fped.2023.1260372. eCollection 2023.

Risk factors for health impairments in children after hospitalization for acute COVID-19 or MIS-C

Aline B Maddux  1 , Cameron C Young  2 , Suden Kucukak  2 , Laura D Zambrano  3 , Margaret M Newhams  2 , Caitlin K Rollins  4 , Natasha B Halasa  5 , Shira J Gertz  6 , Elizabeth H Mack  7 , Stephanie Schwartz  8 , Michele Kong  9 , Laura L Loftis  10 , Katherine Irby  11 , Courtney M Rowan  12 , Keiko M Tarquinio  13 , Matt S Zinter  14 , Hillary Crandall  15 , Natalie Z Cvijanovich  16 , Jennifer E Schuster  17 , Julie C Fitzgerald  18 , Mary A Staat  19 , Charlotte V Hobbs  20 , Ryan A Nofziger  21 , Steven Shein  22 , Heidi Flori  23 , Melissa L Cullimore  24 , Brandon M Chatani  25 , Emily R Levy  26 , Katri V Typpo  27 , Janet R Hume  28 , Angela P Campbell  3 , Adrienne G Randolph  29 ; Overcoming COVID-19 Investigators
Collaborators, Affiliations

Risk factors for health impairments in children after hospitalization for acute COVID-19 or MIS-C

Aline B Maddux et al. Front Pediatr. .

Abstract

Objective: To identify risk factors for persistent impairments after pediatric hospitalization for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C) during the SARS-CoV-2 pandemic.

Methods: Across 25 U.S. Overcoming COVID-19 Network hospitals, we conducted a prospective cohort study of patients <21-years-old hospitalized for acute COVID-19 or MIS-C (May 2020 to March 2022) surveyed 2- to 4-months post-admission. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI).

Results: Of 232 children with acute COVID-19, 71 (30.6%) had persistent symptoms and 50 (21.6%) had activity impairments at follow-up; for MIS-C (n = 241), 56 (23.2%) had persistent symptoms and 58 (24.1%) had activity impairments. In adjusted analyses of patients with acute COVID-19, receipt of mechanical ventilation was associated with persistent symptoms [aRR 1.83 (95% CI: 1.07, 3.13)] whereas obesity [aRR 2.18 (95% CI: 1.05, 4.51)] and greater organ system involvement [aRR 1.35 (95% CI: 1.13, 1.61)] were associated with activity impairment. For patients with MIS-C, having a pre-existing respiratory condition was associated with persistent symptoms [aRR 3.04 (95% CI: 1.70, 5.41)] whereas obesity [aRR 1.86 (95% CI: 1.09, 3.15)] and greater organ system involvement [aRR 1.26 (1.00, 1.58)] were associated with activity impairments.

Discussion: Among patients hospitalized, nearly one in three hospitalized with acute COVID-19 and one in four hospitalized with MIS-C had persistent impairments for ≥2 months post-hospitalization. Persistent impairments were associated with more severe illness and underlying health conditions, identifying populations to target for follow-up.

Keywords: COVID-19; COVID-19 post-intensive care syndrome; MIS-C; SARS-CoV-2; critical care outcomes; multisystem inflammatory syndrome in children; pediatrics; post-acute COVID-19 syndrome.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Enrollment and follow-Up of patients hospitalized for acute COVID-19 or MIS-C.
Figure 2
Figure 2
Outcomes of (A) persistent symptoms and (B) ongoing activity impairment 2- to 4-months after hospitalization among patients admitted for acute COVID-19 and MIS-C.
Figure 3
Figure 3
Mixed effects multivariable models evaluating factors associated with (A) persistent symptoms or (B) activity impairments in patients admitted with acute COVID-19. Variables considered for inclusion in models were age category, sex, SVI category, pre-existing respiratory condition, non-respiratory pre-existing condition, obesity, maximum PELOD-2 score, receipt of mechanical ventilation, duration of mechanical ventilation, cardiovascular dysfunction, and organ systems involved. Patients younger than 2-years-old were considered non-obese.
Figure 4
Figure 4
Mixed effects multivariable models evaluating factors associated with persistent symptoms or activity impairments in patients with MIS-C. Variables considered for inclusion in models were age category, sex, SVI category, pre-existing respiratory condition, non-respiratory pre-existing condition, obesity, maximum PELOD-2 score, receipt of mechanical ventilation, duration of mechanical ventilation, cardiovascular dysfunction, and organ systems involved. Patients younger than 2-years-old were considered non-obese.
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References

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