Study reveals risk factors for severe COVID-19, related syndrome in kids
A prospective cohort study of US children diagnosed as having COVID-19 reveals that certain demographic characteristics, preexisting chronic diseases, and initial vital sign and lab values may portend disease severity, a finding that the researchers said could help improve outcomes.
The University of Colorado-led study involved 167,262 COVID-19 patients 18 years and younger tested for COVID-19 at 56 US National COVID Cohort Collaborative facilities up to Sep 24, 2021, before the emergence of the highly transmissible Omicron SARS-CoV-2 variant.
Among the 10,245 hospitalized children (6.1%), 1,423 (13.9%) were severely ill, with 7.8% requiring mechanical ventilation, 8.5% receiving vasopressor-inotropic support to treat low blood pressure, 0.4% needing extracorporeal membrane oxygenation, and 1.3% dying.
Severe disease was associated with male sex (odds ratio [OR], 1.37), obesity (OR, 1.19) and some pediatric complex chronic condition (PCCC) subcategories. Vital signs and many lab test values from the day of admission were predictive of peak disease severity.
Factors associated with increased odds of multisystem inflammatory syndrome in children (MIS-C), a rare but serious hyperinflammatory complication of COVID-19, included male sex (OR, 1.59), Black race (OR, 1.44), age younger than 12 years (OR, 1.81), obesity (OR, 1.76), and not having a PCCC (OR, 0.72).
The 707 children diagnosed as having MIS-C had a more inflammatory laboratory profile and severe clinical phenotype than the 8,241 with acute illness, with higher rates of invasive ventilation (16.5% vs 6.2%) and need for vasoactive-inotropic cardiac support (27.0% vs 5.2%).
There was no significant change in hospitalization rate before (1,738 patients) and after (8,507) the emergence of the Delta variant (6.0% vs 6.2%), but the odds of severe disease were lower in the Delta era (10.3% vs 14.6%).
"Taken together, these results suggest that early identification of children likely to progress to severe disease could be achieved using readily available data elements from the day of admission," the researchers concluded. "Further work is needed to translate this knowledge into improved outcomes."
Feb 8 JAMA Netw Open study
COVID-19 in college students tied to socioeconomic status, depression
A new study surveying more than 100,000 US college students who were enrolled in the fall of 2020 finds that 7% self-reported a COVID-19 infection, and that self-reporting varied substantially with race, socioeconomic status, parenting status, and student-athlete status.
In addition, students who reported COVID-19 infections were 1.4 times more likely to report anxiety and depression and 1.7 times more likely to report food insecurity. The survey results were published yesterday in Proceedings of the National Academy of Sciences (PNAS).
To conduct the study, the authors sent an electronic survey to more than 1.8 million undergraduates enrolled in 202 colleges and universities in 42 states in the fall of 2020, yielding a response rate of 11%, or roughly 100,000 students. A total of 6,823 respondents (6.8%) said they had had COVID-19, with 10% of Latino students saying they had the virus, compared with 6% of White students.
There were no significant differences between males and females, but students from households of lower socioeconomic standing had substantially higher self-reported rates of infection compared with others (8% vs. 6%, P < 0.01).
Students who were also parents likewise had slightly higher incidences of self-reporting, as did working students and college athletes, who were approximately 2 percentage points more likely to self-report a COVID-19 infection than nonworking or nonathlete students.
"For college athletes, it is possible that this difference is not due to heightened risk of infection but rather that student athletes were tested more often and thus more aware of their infection status," the authors said.
Feb 8 PNAS study