Outcome of COVID-19-positive children with heart disease and grown-ups with congenital heart disease: A multicentric study from India

Sachdeva, Sakshi; Ramakrishnan, Sivasubramanian; Choubey, Mrigank; Koneti, Nageswara Rao; Mani, Kalaivani; Bakhru, Shweta; Gupta, Saurabh Kumar; Gangopadhyay, Debasree; Kasturi, Soumya; Mishra, Jayashree; Nayak, Hemant Kumar; Sivakumar, Kothandam; Bobhate, Prashant; Awasthy, Neeraj; Das, Debasis; Chakrabarti, Manisha; Muthukumaran, Chinnaswamy Sivaprakasam; Saileela, Rajan; Dhulipudi, Bhargavi; Chaudhary, Shiv Kumar; Jayranganath, Mahimarangaiah; Saxena, Anita; Iyer, Krishna Subramony; Kumar, Raman Krishna; Kothari, Shyam S; Kulkarni, Snehal; Rao, Suresh G

BACKGROUND : Outcome data of children with heart disease who acquired COVID-19 infection are limited. AIMS : We sought to analyze outcome data and identify risk factors associated with mortality in children with heart disease and grown-ups with congenital heart disease (GUCH) who had a laboratory-confirmed COVID-19 infection. SETTINGS AND DESIGN : This is a retrospective, multicentric, observational study. MATERIALS AND METHODS : The study included children with heart disease and GUCH population, who presented with either symptomatic or asymptomatic COVID-19 infection to any of the participating centers. COVID-19-negative patients admitted to these centers constituted the control group. RESULTS : From 24 pediatric cardiac centers across India, we included 94 patients with a median age of 12.5 (interquartile range 3–96) months and 49 (52.1%) patients were males. Majority (83 patients, 88.3%) were children. One-third of the patients (n = 31, 33.0%) had acyanotic congenital heart disease, and 41.5% (n = 39) were cyanotic, with > 80% of the patients being unoperated. Only 30 (31.9%) patients were symptomatic for COVID-19 infection, while the rest were incidentally detected positive on screening. A total of 13 patients died (case fatality rate: 13.8%). The in-hospital mortality rate among hospitalized patients was significantly higher among COVID-19-positive cases (13 of 48; 27.1%) as compared to COVID-negative admissions (9.2%) during the study period (P < 0.001). On multivariate analysis, the independent predictors of mortality among COVID-19-positive cases were severity of illness at admission (odds ratio [OR]: 535.7, 95% confidence interval [CI]: 6.9–41,605, P = 0.005) and lower socioeconomic class (OR: 29.5, 95% CI: 1.1–814.7, P = 0.046). CONCLUSIONS : Children with heart disease are at a higher risk of death when they acquire COVID-19 infection. Systematic preventive measures and management strategies are needed for improving the outcomes.