P-1654. Determinants of Severe COVID-19 in Hospitalized Children: Insights from a Multicenter Retrospective Study in Lima, Peru

TL;DR

This study identifies factors linked to severe outcomes in children hospitalized with COVID-19 in Lima, Peru, including low oxygen levels and comorbidities.

Contribution

The study provides insights into risk factors for severe pediatric COVID-19 in a high-impact region with limited prior data.

Findings

Low oxygen saturation at admission was strongly associated with severe disease.

Children born in the Highlands region had higher odds of severe outcomes.

Comorbidities, male sex, and thrombocytopenia were also significant risk factors.

Abstract

Peru has experienced the highest number of COVID-19 deaths per million inhabitants worldwide. Although children were less frequently affected than adults, a substantial number have required hospitalization and experienced severe outcomes. This study aimed to identify factors associated with severe COVID-19 among hospitalized children and adolescents in major hospitals in Lima, Peru.
Median (Q1, Q3), 1OR = Odds Ratio, CI = Confidence Interval, BDP = Bronchopulmonary Dysplasia, CF = Cystic fibrosis

Median (Q1, Q3), 1OR = Odds Ratio, CI = Confidence Interval, BDP = Bronchopulmonary Dysplasia, CF = Cystic fibrosis

A multicenter retrospective study of children and adolescents under 18 years of age hospitalized due to COVID-19 or multisystem inflammatory syndrome in children (MISC) across 15 hospitals in Lima between March 2020 and February 2023. Severe COVID-19 was defined as the requirement for invasive mechanical ventilation, vasopressor or inotropic support, ECMO, or death. To identify factors associated with severe COVID-19 multivariate logistic regression analysis was performed. Odds ratios (OR) with 95% confidence intervals (CI) were calculated.

A total of 4,179 medical records were included. Males accounted for 51.4% (n = 2,116) and children < 5 years accounted for 50.8% (n = 2,125). Comorbidities were reported in 47.0% (n = 1,962) of cases, with asthma (n = 270), prematurity (n = 211), epilepsy (n = 148) and obesity (n = 123) being the most frequent. The overall mortality rate was 2.6% (n = 106); 641 patients met the severity criteria (15.3%) and 3,538 were non-severe. The main diagnosis were pneumonia 22.7% (46.7% vs 18.4% among severe and non-severe cases), respiratory failure 12.1% (51.1% vs 5.0%), sepsis 9.5% (35.8% vs 4.7%) and MISC 8.9% (19.2% vs 7.0%). In the multivariate analysis, oxygen saturation < 90% at admission (OR = 4.64; 95% CI: 3.18–6.77), being born in the Highlands region (OR = 2.16; 95% CI: 1.16–3.90), thrombocytopenia (OR = 1.98; 95% CI: 1.53–2.55), male sex (OR = 1.46; 95% CI: 1.19–1.80), and presence of comorbidities (OR = 1.35; 95% CI: 1.08–1.68) were significantly associated with severe disease.

Severe COVID-19 in children and adolescents hospitalized in Lima was associated with hypoxemia at admission, being born in the Highlands region, thrombocytopenia, male sex and comorbidities.

Rafaella Navarro Hoyos, MD, Pfizer: Grant/Research Support Valerie Mayorga Huallpa, MD, Pfizer: Grant/Research Support Brian Peña Calero, n/a, Pfizer: Grant/Research Support Theresa Ochoa Woodell, PhD, Pfizer: Grant/Research Support

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