RT Journal Article
T1 Clinical spectrum of COVID-19 and risk factors associated with severity in Spanish children.
A1 Tagarro, Alfredo
A1 Cobos-Carrascosa, Elena
A1 Villaverde, Serena
A1 Sanz-Santaeufemia, Francisco-Javier
A1 Grasa, Carlos
A1 Soriano-Arandes, Antoni
A1 Hernanz, Alicia
A1 Navarro, María Luisa
A1 Pino, Rosa
A1 Epalza, Cristina
A1 Batista, Rosa
A1 Rizo, Jana
A1 Iglesias-Bouzas, María-Isabel
A1 Rodríguez-Molino, Paula
A1 Villanueva-Medina, Sara
A1 Carrasco-Colom, Jaime
A1 Alonso-Cadenas, José-Antonio
A1 Mellado, María-José
A1 Herrero, Blanca
A1 Melendo, Susana
A1 De La Torre, Mercedes
A1 Calleja, Lourdes
A1 Calvo, Cristina
A1 Urretavizcaya-Martínez, María
A1 Astigarraga, Itziar
A1 Menasalvas, Ana
A1 Penin, María
A1 Neth, Olaf
A1 Berzosa, Arantxa
A1 De Ceano-Vivas, María
A1 Vidal, Paula
A1 Romero, Isabel
A1 González, Raúl
A1 García, María Luz
A1 Mesa, Juan-Miguel
A1 Ballesteros, Álvaro
A1 Bernardino, María
A1 Moraleda, Cinta
A1 EPICO-AEP Working Group, 
K1 COVID-19
K1 Children
K1 Clinical phenotypes
K1 MIS-C
K1 SARS-CoV-2
K1 Severity
AB We aimed to identify the spectrum of disease in children with COVID-19, and the risk factors for admission in paediatric intensive care units (PICUs). We conducted a multicentre, prospective study of children with SARS-CoV-2 infection in 76 Spanish hospitals. We included children with COVID-19 or multi-inflammatory syndrome (MIS-C) younger than 18 years old, attended during the first year of the pandemic. We enrolled 1200 children. A total of 666 (55.5%) were hospitalised, and 123 (18.4%) required admission to PICU. Most frequent major clinical syndromes in the cohort were mild syndrome (including upper respiratory tract infection and flu-like syndrome, skin or mucosae problems and asymptomatic), 44.8%; bronchopulmonary syndrome (including pneumonia, bronchitis and asthma flare), 18.5%; fever without a source, 16.2%; MIS-C, 10.6%; and gastrointestinal syndrome, 10%. In hospitalised children, the proportions were 28.5%, 25.7%, 16.5%, 19.1% and 10.2%, respectively. Risk factors associated with PICU admission were age in months (OR: 1.007; 95% CI 1.004 to 1.01), MIS-C (OR: 14.4, 95% CI 8.9 to 23.8), chronic cardiac disease (OR: 4.8, 95% CI 1.8 to 13), asthma or recurrent wheezing (OR: 2.5, 95% CI 1.2 to 5.2) and after excluding MIS-C patients, moderate/severe liver disease (OR: 8.6, 95% CI 1.6 to 47.6). However, asthmatic children were admitted into the PICU due to MIS-C or pneumonia, not due to asthma flare.Conclusion: Hospitalised children with COVID-19 usually present as one of five major clinical phenotypes of decreasing severity. Risk factors for PICU include MIS-C, elevation of inflammation biomarkers, asthma, moderate or severe liver disease and cardiac disease. What is Known: • All studies suggest that children are less susceptible to serious SARS-CoV-2 infection when compared to adults. Most studies describe symptoms at presentation. However, it remains unclear how these symptoms group together into clinically identifiable syndromes and the severity associated with them. What is New: • We have gathered the primary diagnoses into five major syndromes of decreasing severity: MIS-C, bronchopulmonary syndrome, gastrointestinal syndrome, fever without a source and mild syndrome. Classification of the children in one of the syndromes is unique and helps to assess the risk of critical illness and to define the spectrum of the disease instead of just describing symptoms and signs.
YR 2021
FD 2021-11-05
LK http://hdl.handle.net/10668/20086
UL http://hdl.handle.net/10668/20086
LA en
DS RISalud
RD Apr 5, 2025