Risk Factors for Pediatric Critical COVID-19: A Systematic Review and Meta-Analysis

Publication date: Jan 17, 2024

Background: Risk stratification is a cornerstone of the Pediatric Infectious Diseases Society COVID-19 treatment guidance. This systematic review and meta-analysis aimed to define the clinical characteristics and comorbidities associated with critical COVID-19 in children and adolescents. Methods: Two independent reviewers screened the literature (Medline and EMBASE) for studies published through August 2023 that reported outcome data on patients aged 21 years or younger with COVID-19. Critical disease was defined as an invasive mechanical ventilation requirement, intensive care unit admission, or death. Random effects models were used to estimate pooled odds ratios (OR) with 95% confidence intervals (CI), and heterogeneity was explored through subgroup analyses. Results: Among 10,178 articles, 136 studies met the inclusion criteria for review. Data from 70 studies, which collectively examined 172,165 children and adolescents with COVID-19, were pooled for meta-analysis. In previously healthy children, the absolute risk of critical disease from COVID-19 was 4% (95% CI, 1%-10%). Compared with no comorbidities, the pooled OR for critical disease was 3.95 (95% CI, 2.78-5.63) for presence of one comorbidity and 9.51 (95% CI, 5.62-16.06) for [≥]2 comorbidities. Key risk factors included cardiovascular and neurological disorders, chronic pulmonary conditions (excluding asthma), diabetes, obesity, and immunocompromise, all with statistically significant ORs >2.00. Conclusions: While the absolute risk for critical COVID-19 in children and adolescents without underlying health conditions is relatively low, the presence of one or more comorbidities was associated with markedly increased risk. These findings support the importance of risk stratification in tailoring pediatric COVID-19 management.

Concepts Keywords
California Adolescents
Hospitalization Certified
Models Comorbidities
Obesity Conditions
Ot2hl161847 Covid


Type Source Name
disease MESH COVID-19
disease MESH Infectious Diseases
disease MESH death
drug DRUGBANK Methionine
disease MESH comorbidity
disease MESH neurological disorders
disease MESH asthma
pathway KEGG Asthma
disease MESH obesity
disease VO effective
disease MESH sequelae
disease MESH syndrome
disease VO population
disease MESH attention deficit hyperactivity disorder
disease IDO quality
disease MESH cirrhosis
disease MESH pancreatic disease
disease MESH inflammatory bowel disease
pathway KEGG Inflammatory bowel disease
disease MESH gastrointestinal diseases
disease VO dose
disease MESH cardiovascular diseases
disease MESH critical illness
disease VO vaccination
disease MESH infections
disease VO vaccine
disease VO time
drug DRUGBANK Montelukast
drug DRUGBANK Hyaluronic acid
disease VO age
drug DRUGBANK Flunarizine
drug DRUGBANK (S)-Des-Me-Ampa
disease MESH Psychosis
disease MESH substance abuse

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