CLINICAL AND LABORATORY PREDICTORS OF SEVERE AND CRITICAL COVID-19 IN HOSPITALIZED CHILDREN
DOI:
https://doi.org/10.18623/rvd.v22.n3.3438Keywords:
COVID-19, Children, Hospitalization, Predictors, SeverityAbstract
Background: Although coronavirus disease 2019 (COVID-19) in children is often mild, some develop severe or critical illness requiring hospitalization. Identifying predictors of severity is vital for timely management, particularly in resource-limited settings. Methods: A retrospective study was conducted on 906 children aged 0–16 years hospitalized with symptomatic COVID-19 at Vietnam National Children’s Hospital. Demographic, clinical, laboratory, and imaging data were reviewed, and disease severity was classified as mild, moderate, severe, or critical. Factors associated with severe or critical outcomes were analyzed using univariate and multivariate logistic regression.
Results: Of 906 cases, 80.5% were mild, 9.9% moderate, 3.6% severe, and 6.0% critical. Severe and critical illness occurred mainly in infants under 12 months, malnourished children, and those with comorbidities. These groups showed higher rates of fever, cough, abnormal chest X-rays, elevated LDH, and lower lymphocyte counts. In multivariate analysis, only LDH > 376 U/L (OR = 10.53, p < 0.001) and chest X-ray abnormalities (OR = 24.24, p < 0.001) remained independent predictors. Conclusion: Most hospitalized children had mild disease, but severe forms were not uncommon. Elevated LDH and chest radiographic abnormalities were key predictors for early identification of high-risk patients.
References
Antoon, J. W., Grijalva, C. G., Thurm, C., Richardson, T., Spaulding, A. B., Teufel, R. J., 2nd, Reyes, M. A., Shah, S. S., Burns, J. E., Kenyon, C. C., Hersh, A. L., & Williams, D. J. (2021). Factors Associated With COVID-19 Disease Severity in US Children and Adolescents. J Hosp Med, 16(10), 603-610. https://doi.org/10.12788/jhm.3689
Flores-Cisneros, L., Gutiérrez-Vargas, R., Escondrillas-Maya, C., Zaragoza-Jiménez, C., Rodríguez, G. G., López-Gatell, H., & González-Islas, D. (2024). Risk factors for severe disease and mortality in children with COVID-19. Heliyon, 10(1), e23629. https://doi.org/10.1016/j.heliyon.2023.e23629
Gastesi, I., Domínguez-Rodríguez, S., Le Prevost, M., Ramírez, A., Giaquinto, C., Mesa, M. L., Ballesteros, A., Jackson, C., Vásquez-Hoyos, P., Alvarez Moreno, C., Grasa, C., Epalza, C., Soriano-Arandes, A., Moraleda, C., & Tagarro, A. (2025). Comorbidities Associated With Different Degrees of Severity in Children and Young People Hospitalized With Acute COVID-19. Pediatr Infect Dis J, 44(5), 439-441. https://doi.org/10.1097/inf.0000000000004684
Huang, S. M., Wu, C. H., Yen, T. Y., Wu, E. T., Wang, C. C., Lu, F. L., Lu, C. Y., Chen, J. M., Lee, P. I., Lee, W. T., Chang, L. Y., & Huang, L. M. (2023). Clinical characteristics and factors associated with severe COVID-19 in hospitalized children during the SARS-CoV-2 Omicron pandemic in Taiwan. J Microbiol Immunol Infect, 56(5), 961-969. https://doi.org/10.1016/j.jmii.2023.06.001
Lin, F., Chen, M. T., Zhang, L., Xie, H., Yang, Z., Huang, B., Wu, J. P., Lin, W. H., & Yang, L. Y. (2024). Hospitalized children with COVID-19 infection during large outbreak of SARS-CoV-2 Omicron strain: a retrospective study in Chaozhou, Guangdong, China. Ann Med, 56(1), 2389301. https://doi.org/10.1080/07853890.2024.2389301
Oliveira, C. R., Willis, Z. I., Maron, G., Sue, P. K., Anosike, B. I., Bio, L., Singh, P., James, S. H., Miller, C. M., Nakamura, M. M., & Wolf, J. (2023). 491. Risk Factors for Severe Pediatric COVID-19: A Systematic Review. Open Forum Infect Dis, 10(Suppl 2). https://doi.org/10.1093/ofid/ofad500.560
Stopyra, L., Kowalik, A., Stala, J., Majchrzak, I., Szebla, J., Jakosz, M., & Kwinta, P. (2022). The Age-Related Course of COVID-19 in Pediatric Patients-1405 Cases in a Single Center. J Clin Med, 11(24). https://doi.org/10.3390/jcm11247347
Verma, S., Lumba, R., Dapul, H. M., Gold-von Simson, G., Phoon, C. K., Lighter, J. L., Farkas, J. S., Vinci, A., Noor, A., Raabe, V. N., Rhee, D., Rigaud, M., Mally, P. V., Randis, T. M., Dreyer, B., Ratner, A. J., Manno, C. S., & Chopra, A. (2021). Characteristics of Hospitalized Children With SARS-CoV-2 in the New York City Metropolitan Area. Hosp Pediatr, 11(1), 71-78. https://doi.org/10.1542/hpeds.2020-001917
Zhou, B., Yuan, Y., Wang, S., Zhang, Z., Yang, M., Deng, X., & Niu, W. (2021). Risk profiles of severe illness in children with COVID-19: a meta-analysis of individual patients. Pediatr Res, 90(2), 347-352. https://doi.org/10.1038/s41390-021-01429-2
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