13 Comorbid Conditions With COVID-19 in Hospitalized Pediatric Patients: A Multi-Center Analysis

Heyming, T.; Spiegelman, L.; Marano, R.; Taraman, S.; Feaster, W.; Keskinocak, P.; Ehwerhemuepha, L.

Background: Although the physical morbidity and mortality attributable to SARS-CoV-2 has predominantly affected adults, children remain at risk for serious complications. There has been substantial research regarding comorbid conditions, such as obesity and diabetes, and COVID-19 outcomes in adults, yet much is still unknown in the pediatric population. Study Objective: This study sought to examine comorbid conditions as risk factors associated with severe outcomes among pediatric COVID-19 patients. Methods: In this cross-sectional retrospective study we used data mining approaches on the Cerner multicenter dataset to retrieve an extensive list of comorbidities including pre-existing and concurrent conditions in hospitalized patients with SARS-CoV-2 (> 29 days and <21 years, hospitalized 3/1-6/30/20). Complications were defined as death or mechanical ventilator use. A nested mixed effects model was built on the most common comorbid conditions. All variables were assessed using the generalized variance inflation factor. Corresponding two-way statistical interactions with age were considered while controlling for patient demographics and payer type;the final model was selected using backward elimination procedures. Results: There were 2480 encounters from 2320 patients;17.1% required a ventilator and 0.85% died (19/21 patients who died required mechanical ventilation). 25.8% of patients were <2, 16% were 6-11, and 29.6% were 12-18. Male patients comprised 52.1%, and 48.3% were White/Caucasian, 21.8% were Hispanic, and 15.1% were African American/Black. Males were at 36% increased odds of complication (IOC), and Black/African American patients were found to be at 63% IOC. Patients with bacterial pneumonia and severe sepsis had 330% and 314% IOC respectively. Heart failure, 738% IOC, coagulation defect, 722% IOC, and patent ductus arteriosus (PDA), 693% IOC, were among the highest risk factors in this study. Obese patients had 246% IOC. Interestingly, the increased risk of complications in patients with epilepsy and acute kidney failure was age dependent. Patients with epilepsy > 5 years were at higher odds of complication and those odds increased with age, whereas younger patients with acute kidney failure were more at risk. The highest risk factor for complication was found to be ileus, OR=11.9. Of 40 patients with ileus, 3 died and 26 required mechanical ventilation. Conclusions: Risk factors for complications of SARS-CoV-2 infection encompass a variety of conditions including obesity, epilepsy, PDA, bacterial pneumonia, sepsis, acute kidney failure, and ileus. Further studies are needed to explore these associations which may help elucidate why certain children suffer increased complications as well as inform treatment decisions.