Comparison of the First and Second Waves of the Coronavirus Disease 2019 Pandemic in Children and Adolescents in a Middle-Income Country: Clinical Impact Associated with Severe Acute Respiratory Syndrome Coronavirus 2 Gamma Lineage - 06/05/22
, Ana Cristina Simões e Silva, PhD 1, Maria Christina L. Oliveira, PhD 1, 2, Enrico A. Colosimo, PhD 3, Robert H. Mak, MD 4, Mariana A. Vasconcelos, PhD 1, Debora M. Miranda, PhD 1, Daniella B. Martelli, PhD 5, Ludmila R. Silva, MSc 6, Clara C. Pinhati, MD 1, Hercílio Martelli-Júnior, PhD 5
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Abstract |
Objective |
To evaluate the severity and clinical outcomes of the SARS-CoV-2 gamma variant in children and adolescents hospitalized with COVID-19 in Brazil.
Study design |
In this observational retrospective cohort study, we performed an analysis of all 21 591 hospitalized patients aged <20 years with confirmed SARS-CoV-2 infection registered in a national database in Brazil. The cohort was divided into 2 groups according to the predominance of SARS-CoV-2 lineages (WAVE1, n = 11 574; WAVE2, n = 10 017). The characteristics of interest were age, sex, geographic region, ethnicity, clinical presentation, and comorbidities. The primary outcome was time to death, which was evaluated by competing-risks analysis, using cumulative incidence functions. A predictive Fine and Gray competing-risks model was developed based on the WAVE1 cohort with temporal validation in the WAVE2 cohort.
Results |
Compared with children and adolescents admitted during the first wave, those admitted during the second wave had significantly more hypoxemia (52.5% vs 41.1%; P < .0001) and intensive care unit admissions (28.3% vs 24.9%; P < .0001) and needed more noninvasive ventilatory support (37.3% vs 31.6%; P < .0001). In-hospital deaths and death rates were 896 (7.7%) in the first wave and 765 (7.6%) in the second wave (P = .07). The prediction model of death included age, ethnicity, region, respiratory symptoms, and comorbidities. In the validation set (WAVE2), the C statistic was 0.750 (95% CI, 0.741-0.758; P < .0001).
Conclusions |
This large national study found a more severe spectrum of risk for pediatric patients with COVID-19 caused by the gamma variant. However, there was no difference regarding the probability of death between the waves.
Le texte complet de cet article est disponible en PDF.Keywords : COVID-19, children, adolescents, gamma variant, clinical prediction model
Abbreviations : AUC, CIF, ICU, SIVEP-Gripe
Plan
| Supported by the National Council for Scientific and Technological Development (CNPq) and the Research Support Foundation of Minas Gerais (FAPEMIG). The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The authors declare no conflicts of interest. |
Vol 244
P. 178 - mai 2022 Retour au numéro
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