A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral

Abstract

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions.

1. Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, et al. Comorbidity and its Impact on Patients with COVID-19. SN Compr Clin Med. 2020;1-8.
2. Keshavarz M, Tavakoli A, Zanganeh S, Mousavi MJ, Vahdat K, Mahmudpour M, et al. Clinical characteristics of outpatients and inpatients with COVID-19 in Bushehr: a report from the south of Iran. Future Virol. 2021;16(2):99-106.
3. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020;145(6):e20200702.
4. Wu Z, McGoogan JM. Characteristics of and important 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;323(13):1239-42.
5. Colson P, Tissot-Dupont H, Morand A, Boschi C, Ninove L, Esteves-Vieira V, et al. Children account for a small proportion of diagnoses of SARS-CoV-2 infection and do not exhibit greater viral loads than adults. Eur J Clin Microbiol Infect Dis. 2020;39(10):1983-7.
6. Gaborieau L, Delestrain C, Bensaid P, Vizeneux A, Blanc P, Garraffo A, et al. Epidemiology and clinical presentation of children hospitalized with SARS-CoV-2 infection in suburbs of Paris. J Clin Med. 2020;9(7):2227.
7. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020;20(6):689-96.
8. Ovali F. Coronavirus-2019 Disease (COVID-19) in Children. Medeni Med J. 2020;35(3):242-52.
9. Alsohime F, Temsah M-H, Al-Nemri AM, Somily AM, Al-Subaie S. COVID-19 infection prevalence in pediatric population: Etiology, clinical presentation, and outcome. J Infect Public Health. 2020;13(12):1791-6.
10. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020;145(6):e20200702.
11. Tagarro A, Epalza C, Santos M, Sanz-Santaeufemia FJ, Otheo E, Moraleda C, et al. Screening and severity of coronavirus disease 2019 (COVID-19) in children in Madrid, Spain. JAMA Pediatr. 2020;e201346.
12. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARS-CoV-2 infection in children. N Engl J Med. 2020;382(17):1663-5.
13. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
14. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.
15. Yang X, Yu Y, Xu J, Shu H, Liu H, Wu Y, 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;8(5):475-81.
16. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
17. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.
18. Mamishi S, Heydari H, Aziz-Ahari A, Shokrollahi MR, Pourakbari B, Mahmoudi S, et al. Novel coronavirus disease 2019 (COVID-19) outbreak in children in Iran: atypical CT manifestations and mortality risk of severe COVID-19 infection. J Microbiol Immunol Infect. 2020; Epub ahead of print.
19. Mahmoudi S, Mehdizadeh M, Badv RS, Navaeian A, Pourakbari B, Rostamyan M, et al. The coronavirus disease 2019 (COVID-19) in children: a study in an Iranian Children’s Referral Hospital. Infect Drug Resist. 2020;13:2649-55.
20. Mohammadi A, Mohebbi I, Pirnejad H, Mirza-Aghazadeh J, Gharebaghi N, Ardakani AA, et al. Clinical and radiological characteristics of pediatric patients with COVID-19: focus on imaging findings. Jpn J Radiol. 2020:1-6.
21. Soltani J, Sedighi I, Shalchi Z, Sami G, Moradveisi B, Nahidi S. Pediatric coronavirus disease 2019 (COVID-19): An insight from west of Iran. North Clin Istanb. 2020;7(3):284-91.
22. Sedighi I, Fahimzad A, Pak N, Khalili M, Shokrollahi MR, Heydari H, et al. A Multi-Center Retrospective Study of Clinical features, Laboratory Characteristics, and Outcomes of 325 Hospitalized Children with Coronavirus Disease 2019 (COVID-19); A Preliminary Report from Iranian Network for Research in Viral Diseases (INRVD). Preprint from Research Square. 2020.
23. Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross CE, McKiernan CA, et al. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020;174(9):868-73.
24. Alfraij A, Alamir AAB, Al-Otaibi AM, Alsharrah D, Aldaithan A, Kamel AM, et al. Characteristics and outcomes of coronavirus disease 2019 (COVID-19) in criticallyill pediatric patients admitted to the intensive care unit: A multicenter retrospective cohort study. J Infect Public Health. 2021;14(2):193-200.
25. Prata-Barbosa A, Lima-Setta F, Santos GRd, Lanziotti VS, Castro REVd, Souza DCd, et al. Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study. J Pediatr (Rio J).2020;96(5):582-92.
26. Kotecha RS. Challenges posed by COVID-19 to children with cancer. Lancet Oncol. 2020;21(5):e235.
27. Tawbi H. A promising start for checkpoint inhibitors in childhood malignancies. The Lancet Oncology. 2020;21(1):13-4.
28. Cesaro S, Compagno F, Zama D, Meneghello L, Giurici N, Soncini E, et al. Screening for SARS‐CoV‐2 infection in pediatric oncology patients during the epidemic peak in Italy. Pediatr Blood Cancer. 2020;67(8):e28466..
29. Boulad F, Kamboj M, Bouvier N, Mauguen A, Kung AL. COVID-19 in Children With Cancer in New York City. JAMA Oncol. 2020;6(9):1459-60.
30. Hrusak O, Kalina T, Wolf J, Balduzzi A, Provenzi M, Rizzari C, et al. Flash survey on SARS-CoV-2 infections in pediatric patients on anti-cancer treatment. Eur J Cancer. 2020;132:11-6.
31. Bisogno G, Provenzi M, Zama D, Tondo A, Meazza C, Colombini A, et al. Clinical Characteristics and Outcome of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Italian Pediatric Oncology Patients: A Study From the Infectious Diseases Working Group of the Associazione Italiana di Oncologia e Ematologia Pediatrica. J Pediatric Infect Dis Soc. 2020;9(5):530-4.
32. Chao JY, Derespina KR, Herold BC, Goldman DL, Aldrich M, Weingarten J, et al. Clinical characteristics and outcomes of hospitalized and critically ill children and adolescents with coronavirus disease 2019 (COVID-19) at a Tertiary Care Medical Center in New York City. J Pediatr. 2020;223:14-9.e2.
33. Bhumbra S, Malin S, Kirkpatrick L, Khaitan A, John CC, Rowan CM, et al. Clinical features of critical coronavirus disease 2019 in children. Pediatr Crit Care Med. 2020;21(10):e948.
34. Stewart DJ, Hartley JC, Johnson M, Marks SD, du Pré P, Stojanovic J. Renal dysfunction in hospitalised children with COVID-19. Lancet Child Adolesc Health. 2020;4(8):e28-9.
35. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. lancet. 2020;395(10229):1054-62.
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IssueVol 5 No 4 (2021): Autumn (October) QRcode
SectionOriginal article
Published2021-07-04
DOI 10.18502/fem.v5i4.6692
Keywords
COVID-19 Intensive Care Units Pediatric Respiratory Tract Infections SARS-CoV-2

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Fahimzad A, Sedighi I, Pak N, Khalili M, Farahmand M, Shokrollahi MR, Heydari H, Movahedi Z, Sanaei Dashti A, Cheraghali F, Shamsizadeh A, Mirkarimi M, Alisamir M, Hashemian H, Soltani J, Hosseininasab A, Hamedi A, Rezai MS, Sayyahfar S, Kahbazi M, Abedini A, Akhondzadeh A, Sherkatolabbasieh HR, Razlansari AA, Alibeik M, Malayeri SO, Shalchi Z, Shahabinezhad A, Khalkhali Asl P, Erfani Y, Norouzi M, Nafe Monfared F, Maleki S, Kakavand R, Shahbaz B, Poortahmasebi V, Akhavan Rezayat S, Karimi MR, Jafarpour A, Soltani S, Ghaziasadi A, Dowran R, Azimi S, Sadeghipour Marvi S, Abazari F, Zandi M, Jazayeri SM, Tavakoli A. A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral. Front Emerg Med. 5(4):e41.

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