Predictors of Death in Severe New Coronavirus Infection in Children

Currently, in pandemic settings, the new coronavirus infection is the leading cause of adult fatalities and may cause death of children with comorbidities.

The objective of the study is to identify predictors of the fatality of the new coronavirus infection in children.

Subjects and Methods. 230 patients with the new coronavirus infections were examined. The main group of 94 patients with severe COVID-19, the fatal outcome occurred in 25 (26.6%) children. The comparison group consisted of 126 children with a moderate degree of severity, and there 
were no lethal outcomes.

Results. Children older than 10 years of age (43%) prevailed in the study cohort. Every fifth patient in the main group suffered from shock, and 79 (84%) children had failure of two or more systems/organs. The presence of pronounced manifestations of the disease was associated with a 20-fold increase in the probability of a severe course of COVID-19 (OR = 0.04). Involvement of two organs and systems doubled the risk of death. An acceptable discriminatory ability of the pSOFA score for predicting COVID-19 outcomes in children was identified: sensitivity 83%, specificity 61%, cut-off point 5.6 points.

Conclusion. Predictors of death in severe new coronavirus infection in children include failure of two or more organs and systems, acute renal injury and the pSOFA score above 5.

1. Аleksandrovich Yu. S., Аlekseeva E. I., Bakradze M. D. et al. Guidelines on specific clinical signs and treatment of disorders caused by the new coronavirus infection (COVID-19) in children. Pediatricheskaya Pharmocologiya, 2020, vol. 17, no. 3, pp. 187-212. (In Russ.) https://doi.org/10.15690/pf.v17i3.2123.

2. Mamaev А. N, Kudlay D. A. Statisticheskiye metody v meditsine. [Statistical methods in medicine]. Moscow, Prakticheskaya Meditsina Publ., 2021. 136 p.

3. Pshenisnov K. V., Аleksandrovich Yu. S., Kaziakhmedov V. A. et al. A new coronavirus infection in children with comorbidities: there is always a chance for recovery. Journal Infektologii, 2020, vol. 12, no. 3, pp. 80-89. (In Russ.) https://doi.org/10.22625/2072-6732-2020-12-3-80-89.

4. Bousquet J., Zuberbier T., Anto J. M., Iaccarino G., Czarlewski W., Anto A., Haahtela T., Akdis C. A., Blain H., Canonica G. W., Cardona V., Cruz A. A., Illario M., Ivancevich J. C., Jutel M., Klimek L., Kuna P., Laune D., Larenas-Linnemann D., Mullol J. et al. Is diet partly responsible for differences in covid-19 death rates between and within countries? Clin. Translat. Allergy, 2020, vol. 10, no. 1, pp. 16. https://doi.org/doi.org/10.1186/s13601-020-00323-0.

5. Chao J. Y., Derespina K. R., Herold B. C. et al. Clinical characteristics and outcomes of hospitalized and critically ill children and adolescents with coronavirus disease 2019 at a tertiary care medical center in New York City. J. Pediatr., 2020, vol. 223, pp. 14-19.e2. https://doi.org/10.1016/j.jpeds.2020.05.006.

6. Dong Y., Mo X., Hu Y. et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics, 2020, vol. 58, no. 4, pp. 712-713. https://doi.org/10.1542/peds.2020-0702.

7. Graff K., Smith C., Silveira L. et al. Risk factors for severe COVID-19 in children. Pediatr. Infect. Dis. J., 2021, vol. 40, no. 4, pp. https://doi.org/-e145.doi:10.1097/INF.0000000000003043.

8. Kabarriti R., Brodin N. P., Maron M. I. et al. Association of race and ethnicity with comorbidities and survival among patients with COVID-19 at an urban medical center in New York. JAMA Network Open, 2020, vol. 3, no. 9, pp. e2019795. https://doi.org/10.1001/jamanetworkopen.2020.19795.

9. Kompaniyets L., Agathis N. T., Nelson J. M. et al Underlying Medical Conditions Associated With Severe COVID-19 Illness Among Children. JAMA Network Open, 2021, vol. 4, no. 6, pp. e2111182. https://doi.org/10.1001/jamanetworkopen.2021.11182.

10. Raith E. P, Udy A. A., Bailey M. et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA, 2017, vol. 317, no. 3, pp. 290-300. https://doi.org/10.1001/jama.2016.20328.

11. Raschke R. A., Agarwal S., Rangan P. et al. Discriminant accuracy of the sofa score for determining the probable mortality of patients with COVID-19 pneumonia requiring mechanical ventilation. JAMA, 2021, vol. 325, no. 14, pp. 1469-1470. https://doi.org/10.1001/jama.2021.1545.

12. Shekerdemian L. S., Mahmood N. R., Wolfe K. K. et al. International COVID-19 PICU Collaborative. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr., 2020, vol. 174, no. 9, pp. 868-873. https://doi.org/10.1001/jamapediatrics.2020.1948.

13. Tsankov B. K., Allaire J. M., Irvine M. A. et al. Severe COVID-19 infection and pediatric comorbidities: a systematic review and meta-analysis. Int. J. Infect. Dis., 2021, vol. 103, pp. 246-256. https://doi.org/10.1016/j.ijid.2020.11.163.

14. Wu Z., McGoogan J. M. Characteristics of and im portant lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA, 2020, vol. 323, no. 13, pp. 1239-1242. https://doi.org/10.1001/jama.2020.2648.

15. Yang X., Yu Y., Xu J. et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir. Med., 2020, vol. 8, no. 5, pp. 475-481. https://doi.org/10.1016/S2213-2600(20)30079-5.