Factors Associated with Adverse Outcomes among SARS-CoV-2 Positive Children in a Tertiary Government COVID-19 Referral Hospital in the Philippines
Mark Jason Dc. Milan, Md, Al Joseph R Molina, Md, Anna Lisa T Ong-Lim, Md, Ma. Esterlita V Uy, Md, Ms, Herbert G Uy, Md
Acta Medica Philippina, doi:10.47895/amp.v58i7.8392
Background and Objective. Pediatric COVID-19 epidemiology and factors associated with adverse outcomesmortality, need for invasive mechanical ventilation, and ICU admission, are largely unstudied. We described the clinicodemographic characteristics of Filipino pediatric COVID-19 patients and determined the factors associated with adverse outcomes. Methods. This is a retrospective cohort study of 180 hospitalized SARS-CoV-2-confirmed cases 0-18 years old from April 2020 to August 2021 in a tertiary COVID-19 referral hospital in Manila, National Capital Region. Crude associations were determined using chi-squared or Fisher's exact tests; and medians were compared using the Mann-Whitney test. Factors predictive of mortality were determined using Cox proportional hazards regression analysis. The survivor functions were depicted in graphs. Results. About 41.67% had mild disease, 58.33% were males, 39.4% aged 0-4 years, and 69.44% had at least one comorbidity. About 9.44% died (adjusted 9.2 persons per 1000 patient-days, 95% CI 5.5%-15.2%), 17.78% needed invasive mechanical ventilation, and 20% needed ICU admission. Independently, severe-critical COVID-19 (HRc 11.51, 95% CI 3.23, 41.06), retractions (HRc 10.30, 95% CI 3.27, 32.47), alar flaring (HRc 4.39, 95% CI 1.53, 12.58), cyanosis (HRc 4.39, 95% CI 1.72, 14.11), difficulty of breathing (HRc 7.99, 95% CI 2.25, 28.71), poor suck/appetite (HRc 4.46, 95% CI 1.59, 12.40), ferritin (HRc 1.01, 95% CI 1.00, 1.01), IL-6 (HRc 1.01, 95% CI 1.00, 1.01), aPTT (HRc 1.05, 95% CI 1.01, 1.10), IVIg (HRc 4.00, 95% CI 1.07, 14.92) and corticosteroid (HRc 6.01, 95% CI 2.04, 17.67) were significant hazards for mortality. In adjusted Cox analysis, only retractions (HRa 34.96, 95% CI 3.36, 363.79), seizure (HRa 9.98, 95% CI 1.76, 56.55), and corticosteroids (HRa 8.21, 95% CI 1.12, 60.38) were significantly associated with mortality while alar flaring appeared to be protective (HRa 0.10, 95% CI 0.01, 0.95). Several clinical characteristics were consistently associated with adverse outcomes. Conclusions. Majority of hospitalized pediatric COVID-19 patients were very young, males, had mild disease, and had at least one comorbidity. Mortality, invasive mechanical ventilation, and ICU admission were relatively low. Except for alar flaring which appeared to be protective, retractions, seizure, and use of corticosteroids were associated with adverse outcomes.
Statement of Authorship All authors certified fulfillment of ICMJE authorship criteria.
Author Disclosure All authors declared no conflicts of interest.
Appendix. Survival functions after Cox regression analysis, adjusted
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'abstract': '<jats:p>Background and Objective. Pediatric COVID-19 epidemiology and factors associated with '
'adverse outcomes –mortality, need for invasive mechanical ventilation, and ICU admission, are '
'largely unstudied. We described the clinicodemographic characteristics of Filipino pediatric '
'COVID-19 patients and determined the factors associated with adverse outcomes.\r\n'
'Methods. This is a retrospective cohort study of 180 hospitalized SARS-CoV-2-confirmed cases '
'0-18 years oldfrom April 2020 to August 2021 in a tertiary COVID-19 referral hospital in '
'Manila, National Capital Region. Crudeassociations were determined using chi-squared or '
'Fisher’s exact tests; and medians were compared using the Mann-Whitney test. Factors '
'predictive of mortality were determined using Cox proportional hazards regression analysis. '
'The survivor functions were depicted in graphs.\r\n'
'Results. About 41.67% had mild disease, 58.33% were males, 39.4% aged 0-4 years, and 69.44% '
'had at least onecomorbidity. About 9.44% died (adjusted 9.2 persons per 1000 patient-days, '
'95% CI 5.5%-15.2%), 17.78% needed invasive mechanical ventilation, and 20% needed ICU '
'admission. Independently, severe-critical COVID-19 (HRc 11.51, 95% CI 3.23, 41.06), '
'retractions (HRc 10.30, 95% CI 3.27, 32.47), alar flaring (HRc 4.39, 95% CI 1.53, 12.58), '
'cyanosis (HRc 4.39, 95% CI 1.72, 14.11), difficulty of breathing (HRc 7.99, 95% CI 2.25, '
'28.71), poor suck/appetite (HRc 4.46, 95% CI 1.59, 12.40), ferritin (HRc 1.01, 95% CI 1.00, '
'1.01), IL-6 (HRc 1.01, 95% CI 1.00, 1.01), aPTT (HRc 1.05, 95% CI 1.01, 1.10), IVIg (HRc '
'4.00, 95% CI 1.07, 14.92) and corticosteroid (HRc 6.01, 95% CI 2.04, 17.67) were significant '
'hazards for mortality. In adjusted Cox analysis, only retractions (HRa 34.96, 95% CI 3.36, '
'363.79), seizure (HRa 9.98, 95% CI 1.76, 56.55), and corticosteroids (HRa 8.21, 95% CI 1.12, '
'60.38) weresignificantly associated with mortality while alar flaring appeared to be '
'protective (HRa 0.10, 95% CI 0.01,0.95). Several clinical characteristics were consistently '
'associated with adverse outcomes.\r\n'
'Conclusions. Majority of hospitalized pediatric COVID-19 patients were very young, males, had '
'milddisease, and had at least one comorbidity. Mortality, invasive mechanical ventilation, '
'and ICU admission wererelatively low. Except for alar flaring which appeared to be '
'protective, retractions, seizure, and use ofcorticosteroids were associated with adverse '
'outcomes.\r\n'
'\xa0</jats:p>',
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