TY - JOUR
T1 - Pre-existing Immunocompromising Conditions and Outcomes of Acute COVID-19 Patients Admitted for Pediatric Intensive Care
AU - Overcoming COVID-19 Investigators
AU - Rowan, Courtney M.
AU - LaBere, Brenna
AU - Young, Cameron C.
AU - Zambrano, Laura D.
AU - Newhams, Margaret M.
AU - Kucukak, Suden
AU - McNamara, Elizabeth R.
AU - Mack, Elizabeth H.
AU - Fitzgerald, Julie C.
AU - Irby, Katherine
AU - Maddux, Aline B.
AU - Schuster, Jennifer E.
AU - Kong, Michele
AU - Dapul, Heda
AU - Schwartz, Stephanie P.
AU - Bembea, Melania M.
AU - Loftis, Laura L.
AU - Kolmar, Amanda R.
AU - Babbitt, Christopher J.
AU - Nofziger, Ryan A.
AU - Hall, Mark W.
AU - Gertz, Shira J.
AU - Cvijanovich, Natalie Z.
AU - Zinter, Matt S.
AU - Halasa, Natasha B.
AU - Bradford, Tamara T.
AU - McLaughlin, Gwenn E.
AU - Singh, Aalok R.
AU - Hobbs, Charlotte V.
AU - Wellnitz, Kari
AU - Staat, Mary A.
AU - Coates, Bria M.
AU - Crandall, Hillary R.
AU - Maamari, Mia
AU - Havlin, Kevin M.
AU - Schwarz, Adam J.
AU - Carroll, Christopher L.
AU - Levy, Emily R.
AU - Moffitt, Kristin L.
AU - Campbell, Angela P.
AU - Randolph, Adrienne G.
AU - Chou, Janet
N1 - Publisher Copyright:
© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
PY - 2024/8/15
Y1 - 2024/8/15
N2 - Background. We aimed to determine if pre-existing immunocompromising conditions (ICCs) were associated with the presentation or outcome of patients with acute coronavirus disease 2019 (COVID-19) admitted for pediatric intensive care. Methods. Fifty-five hospitals in 30 US states reported cases through the Overcoming COVID-19 public health surveillance registry. Patients <21 years admitted 12 March 2020–30 December 2021 to the pediatric intensive care unit (PICU) or high-acuity unit for acute COVID-19 were included. Results. Of 1274 patients, 105 (8.2%) had an ICC, including 33 (31.4%) hematologic malignancies, 24 (22.9%) primary immunodeficiencies and disorders of hematopoietic cells, 19 (18.1%) nonmalignant organ failure with solid-organ transplantation, 16 (15.2%) solid tumors, and 13 (12.4%) autoimmune disorders. Patients with ICCs were older, had more underlying renal conditions, and had lower white blood cell and platelet counts than those without ICCs, but had similar clinical disease severity upon admission. In-hospital mortality from COVID-19 was higher (11.4% vs 4.6%, P = .005) and hospitalization was longer (P = .01) in patients with ICCs. New major morbidities upon discharge were not different between those with and without ICC (10.5% vs 13.9%, P = .40). In patients with ICCs, bacterial coinfection was more common in those with life-threatening COVID-19. Conclusions. In this national case series of patients <21 years of age with acute COVID-19 admitted for intensive care, existence of a prior ICCs were associated with worse clinical outcomes. Reassuringly, most patients with ICCs hospitalized in the PICU for severe acute COVID-19 survived and were discharged home without new severe morbidities.
AB - Background. We aimed to determine if pre-existing immunocompromising conditions (ICCs) were associated with the presentation or outcome of patients with acute coronavirus disease 2019 (COVID-19) admitted for pediatric intensive care. Methods. Fifty-five hospitals in 30 US states reported cases through the Overcoming COVID-19 public health surveillance registry. Patients <21 years admitted 12 March 2020–30 December 2021 to the pediatric intensive care unit (PICU) or high-acuity unit for acute COVID-19 were included. Results. Of 1274 patients, 105 (8.2%) had an ICC, including 33 (31.4%) hematologic malignancies, 24 (22.9%) primary immunodeficiencies and disorders of hematopoietic cells, 19 (18.1%) nonmalignant organ failure with solid-organ transplantation, 16 (15.2%) solid tumors, and 13 (12.4%) autoimmune disorders. Patients with ICCs were older, had more underlying renal conditions, and had lower white blood cell and platelet counts than those without ICCs, but had similar clinical disease severity upon admission. In-hospital mortality from COVID-19 was higher (11.4% vs 4.6%, P = .005) and hospitalization was longer (P = .01) in patients with ICCs. New major morbidities upon discharge were not different between those with and without ICC (10.5% vs 13.9%, P = .40). In patients with ICCs, bacterial coinfection was more common in those with life-threatening COVID-19. Conclusions. In this national case series of patients <21 years of age with acute COVID-19 admitted for intensive care, existence of a prior ICCs were associated with worse clinical outcomes. Reassuringly, most patients with ICCs hospitalized in the PICU for severe acute COVID-19 survived and were discharged home without new severe morbidities.
KW - bacterial coinfection
KW - COVID-19
KW - critical care
KW - immunocompromised host
KW - pediatrics
UR - https://www.scopus.com/pages/publications/85201436935
U2 - 10.1093/cid/ciae133
DO - 10.1093/cid/ciae133
M3 - Article
C2 - 38465976
AN - SCOPUS:85201436935
SN - 1058-4838
VL - 79
SP - 395
EP - 404
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 2
ER -