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Causes of Intensive Care Unit Admissions in Children with SARS-CoV-2: A Single-Centre Observational Study

Background: The proportion of intensive care unit (ICU) admissions in children that have and have not been directly caused by SARS-CoV-2 remains unclear. The aim of the study is to analyse a cohort of children admitted to the ICU with SARS-CoV-2 and determine whether the infection was the primary ca...

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Autores principales: Homola, Lukáš, Klučka, Jozef, Fabián, Dominik, Štourač, Petr, Šikula, Josef, Vávrová, Eva, Jeřábková, Barbora, Sihlovec, Martin, Musil, Václav, Španělová, Klára, Mužlayová, Patricia, Danhofer, Pavlína
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9856882/
https://www.ncbi.nlm.nih.gov/pubmed/36670627
http://dx.doi.org/10.3390/children10010075
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author Homola, Lukáš
Klučka, Jozef
Fabián, Dominik
Štourač, Petr
Šikula, Josef
Vávrová, Eva
Jeřábková, Barbora
Sihlovec, Martin
Musil, Václav
Španělová, Klára
Mužlayová, Patricia
Danhofer, Pavlína
author_facet Homola, Lukáš
Klučka, Jozef
Fabián, Dominik
Štourač, Petr
Šikula, Josef
Vávrová, Eva
Jeřábková, Barbora
Sihlovec, Martin
Musil, Václav
Španělová, Klára
Mužlayová, Patricia
Danhofer, Pavlína
author_sort Homola, Lukáš
collection PubMed
description Background: The proportion of intensive care unit (ICU) admissions in children that have and have not been directly caused by SARS-CoV-2 remains unclear. The aim of the study is to analyse a cohort of children admitted to the ICU with SARS-CoV-2 and determine whether the infection was the primary cause of their hospitalisation, a significant contributor, a suspected accomplice, or an incidental finding. Methods: This was a retrospective observational study of all the children admitted to the ICU with SARS-CoV-2 from March 2020 to February 2022 from the South Moravia region. The aim of the study was to assess whether the hospitalisation was likely to be directly caused by the virus (i.e., patients with acute COVID-19; the COVID group), whether the virus was a significant contributor to the hospitalisation (i.e., patients with multisystem inflammatory syndrome in children due to COVID-19; the MIS-C group), whether it may have contributed to the worsening of their underlying disease (the WORSENING group), or whether it was an incidental finding very likely unrelated to hospitalisation where SARS-CoV-2 positivity merely placed patients in the COVID-19 unit (the ISOLATION group). The groups were compared using a series of secondary outcomes. Results: The study population represented 150 paediatric ICU cases (age 8.6; IQR 3.5–13.3 years), with 66.7% being male. The COVID group represented 32.7% of cases (49/150); MIS-C, 30% (45/150); WORSENING, 14.7% (22/150); and ISOLATION, 22.7% (34/150). The median length of hospitalisation was found for the MIS-C group (11 days; 9 days in the ICU), the COVID group (6 days; five days in the ICU), WORSENING group (4.5 days; 4.5 days in the ICU) and the ISOLATION group (5.5 days; 3.5 days in the ICU), where the difference was significant (p < 0.001). Asymptomatic and mild cases were most common in the WORSENING (36.4% and 63.6%) and ISOLATION (52.9% and 44.1%) groups. Severe and critical cases were only present in the COVID (6.1% and 12.2%) and MIS-C (4.4% and 11.1%) groups; the severity difference was significant (p < 0.001). The groups did not differ significantly in the proportion of complete recovery and short- and long-term sequelae (p = 0.09). Conclusions: Patients with acute COVID-19 accounted for one-third of all ICU admissions, patients with MIS-C accounted for approximately another third, patients with worsening underlying disease accounted for 15%, and patients with incidental findings of SARS-CoV-2 positivity accounted for one-fifth of ICU admissions. A more significant disease was seen with acute COVID-19 and MIS-C.
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spelling pubmed-98568822023-01-21 Causes of Intensive Care Unit Admissions in Children with SARS-CoV-2: A Single-Centre Observational Study Homola, Lukáš Klučka, Jozef Fabián, Dominik Štourač, Petr Šikula, Josef Vávrová, Eva Jeřábková, Barbora Sihlovec, Martin Musil, Václav Španělová, Klára Mužlayová, Patricia Danhofer, Pavlína Children (Basel) Article Background: The proportion of intensive care unit (ICU) admissions in children that have and have not been directly caused by SARS-CoV-2 remains unclear. The aim of the study is to analyse a cohort of children admitted to the ICU with SARS-CoV-2 and determine whether the infection was the primary cause of their hospitalisation, a significant contributor, a suspected accomplice, or an incidental finding. Methods: This was a retrospective observational study of all the children admitted to the ICU with SARS-CoV-2 from March 2020 to February 2022 from the South Moravia region. The aim of the study was to assess whether the hospitalisation was likely to be directly caused by the virus (i.e., patients with acute COVID-19; the COVID group), whether the virus was a significant contributor to the hospitalisation (i.e., patients with multisystem inflammatory syndrome in children due to COVID-19; the MIS-C group), whether it may have contributed to the worsening of their underlying disease (the WORSENING group), or whether it was an incidental finding very likely unrelated to hospitalisation where SARS-CoV-2 positivity merely placed patients in the COVID-19 unit (the ISOLATION group). The groups were compared using a series of secondary outcomes. Results: The study population represented 150 paediatric ICU cases (age 8.6; IQR 3.5–13.3 years), with 66.7% being male. The COVID group represented 32.7% of cases (49/150); MIS-C, 30% (45/150); WORSENING, 14.7% (22/150); and ISOLATION, 22.7% (34/150). The median length of hospitalisation was found for the MIS-C group (11 days; 9 days in the ICU), the COVID group (6 days; five days in the ICU), WORSENING group (4.5 days; 4.5 days in the ICU) and the ISOLATION group (5.5 days; 3.5 days in the ICU), where the difference was significant (p < 0.001). Asymptomatic and mild cases were most common in the WORSENING (36.4% and 63.6%) and ISOLATION (52.9% and 44.1%) groups. Severe and critical cases were only present in the COVID (6.1% and 12.2%) and MIS-C (4.4% and 11.1%) groups; the severity difference was significant (p < 0.001). The groups did not differ significantly in the proportion of complete recovery and short- and long-term sequelae (p = 0.09). Conclusions: Patients with acute COVID-19 accounted for one-third of all ICU admissions, patients with MIS-C accounted for approximately another third, patients with worsening underlying disease accounted for 15%, and patients with incidental findings of SARS-CoV-2 positivity accounted for one-fifth of ICU admissions. A more significant disease was seen with acute COVID-19 and MIS-C. MDPI 2022-12-30 /pmc/articles/PMC9856882/ /pubmed/36670627 http://dx.doi.org/10.3390/children10010075 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Homola, Lukáš
Klučka, Jozef
Fabián, Dominik
Štourač, Petr
Šikula, Josef
Vávrová, Eva
Jeřábková, Barbora
Sihlovec, Martin
Musil, Václav
Španělová, Klára
Mužlayová, Patricia
Danhofer, Pavlína
Causes of Intensive Care Unit Admissions in Children with SARS-CoV-2: A Single-Centre Observational Study
title Causes of Intensive Care Unit Admissions in Children with SARS-CoV-2: A Single-Centre Observational Study
title_full Causes of Intensive Care Unit Admissions in Children with SARS-CoV-2: A Single-Centre Observational Study
title_fullStr Causes of Intensive Care Unit Admissions in Children with SARS-CoV-2: A Single-Centre Observational Study
title_full_unstemmed Causes of Intensive Care Unit Admissions in Children with SARS-CoV-2: A Single-Centre Observational Study
title_short Causes of Intensive Care Unit Admissions in Children with SARS-CoV-2: A Single-Centre Observational Study
title_sort causes of intensive care unit admissions in children with sars-cov-2: a single-centre observational study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9856882/
https://www.ncbi.nlm.nih.gov/pubmed/36670627
http://dx.doi.org/10.3390/children10010075
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