SARS-CoV-2 Clinical Syndromes and Predictors of Disease Severity in Hospitalized Children and Youth

Fernandes, Danielle M.; Oliveira, Carlos R.; Guerguis, Sandra; Eisenberg, Ruth; Choi, Jaeun; Kim, Mimi; Abdelhemid, Ashraf; Agha, Rabia; Agarwal, Saranga; Aschner, Judy L.; Avner, Jeffrey R.; Ballance, Cathleen; Bock, Joshua; Bhavsar, Sejal M.; Campbell, Melissa; Clouser, Katharine N.; Gesner, Matthew; Goldman, David L.; Hammerschlag, Margaret R.; Hymes, Saul; Howard, Ashley; Jung, Hee-jin; Kohlhoff, Stephan; Kojaoghlanian, Tsoline; Lewis, Rachel; Nachman, Sharon; Naganathan, Srividya; Paintsil, Elijah; Pall, Harpreet; Sy, Sharlene; Wadowski, Stephen; Zirinsky, Elissa; Cabana, Michael D.; Herold, Betsy C.

OBJECTIVE: To characterize the demographic and clinical features of pediatric SARS-CoV-2 syndromes and identify admission variables predictive of disease severity. STUDY DESIGN: We conducted a multicenter, retrospective and prospective study of pediatric patients hospitalized with acute SARS-CoV-2 infections and multisystem inflammatory syndrome in children (MIS-C) at eight sites in New York, New Jersey, and Connecticut. RESULTS: We identified 281 hospitalized patients with SARS-CoV-2 infections and divided them into three groups based on clinical features. Overall, 143 (51%) had respiratory disease, 69 (25%) had MIS-C, and 69 (25%) had other manifestations including gastrointestinal illness or fever. Patients with MIS-C were more likely to identify as non-Hispanic black compared with patients with respiratory disease (35% versus 18%, P=.02). Seven patients (2%) died and 114 (41%) were admitted to the ICU. In multivariable analyses, obesity (OR=3.39, 95% CI:1.26-9.10, P=.02) and hypoxia on admission (OR=4.01; 95% CI:1.14-14.15; P=.03) were predictive of severe respiratory disease. Lower absolute lymphocyte count (OR=8.33 per unit decrease in 10(9) cells/L, 95% CI:2.32-33.33, P=.001) and higher C-reactive protein (OR=1.06 per unit increase in mg/dL, 95% CI:1.01-1.12, P=.017) were predictive of severe MIS-C. Race/ethnicity or socioeconomic status were not predictive of disease severity. CONCLUSIONS: We identified variables at the time of hospitalization that may help predict the development of severe SARS-CoV-2 disease manifestations in children and youth. These variables may have implications for future prognostic tools that inform hospital admission and clinical management.