Background

COVID-19 is usually less severe and has lower case fatality in children than in adults. We aimed to characterise the clinical features of children and adolescents hospitalised with laboratory-confirmed SARS-CoV-2 infection and to evaluate the risk factors for COVID-19-related death in this population.

Methods

We did an analysis of all patients younger than 20 years who had quantitative RT-PCR-confirmed COVID-19 and were registered in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe, a nationwide surveillance database of patients admitted to hospital with severe acute respiratory disease in Brazil), between Feb 16, 2020, and Jan 9, 2021. The primary outcome was time to recovery (discharge) or in-hospital death, evaluated by competing risks analysis using the cumulative incidence function.

Findings

Of the 82 055 patients younger than 20 years reported to SIVEP-Gripe during the study period, 11 613 (14·2%) had available data showing laboratory-confirmed SARS-CoV-2 infection and were included in the sample. Among these patients, 886 (7·6%) died in hospital (at a median 6 days [IQR 3–15] after hospital admission), 10 041 (86·5%) patients were discharged from the hospital, 369 (3·2%) were in hospital at the time of analysis, and 317 (2·7%) were missing information on outcome. The estimated probability of death was 4·8% during the first 10 days after hospital admission, 6·7% during the first 20 days, and 8·1% at the end of follow-up. Probability of discharge was 54·1% during the first 10 days, 78·4% during the first 20 days, and 92·0% at the end of follow-up. Our competing risks multivariate survival analysis showed that risk of death was increased in infants younger than 2 years (hazard ratio 2·36 [95% CI 1·94–2·88]) or adolescents aged 12–19 years (2·23 [1·84–2·71]) relative to children aged 2–11 years; those of Indigenous ethnicity (3·36 [2·15–5·24]) relative to those of White ethnicity; those living in the Northeast region (2·06 [1·68–2·52]) or North region (1·55 [1·22–1·98]) relative to those in the Southeast region; and those with one (2·96 [2·52–3·47]), two (4·96 [3·80–6·48]), or three or more (7·28 [4·56–11·6]) pre-existing medical conditions relative to those with none.

Interpretation

Death from COVID-19 was associated with age, Indigenous ethnicity, poor geopolitical region, and pre-existing medical conditions. Disparities in health care, poverty, and comorbidities can contribute to magnifying the burden of COVID-19 in more vulnerable and socioeconomically disadvantaged children and adolescents in Brazil.

Funding

National Council for Scientific and Technological Development, Research Support Foundation of Minas Gerais.

中文翻译：

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巴西 COVID-19 住院儿童和青少年死亡的临床特征和危险因素：对全国数据库的分析

背景

与成人相比，COVID-19 在儿童中的严重程度通常较低，病死率也较低。我们旨在描述因实验室确诊的 SARS-CoV-2 感染而住院的儿童和青少年的临床特征，并评估该人群中 COVID-19 相关死亡的危险因素。

方法

我们对所有 20 岁以下的患者进行了分析，这些患者进行了定量 RT-PCR 确认的 COVID-19，并在流感流行病学监测信息系统（SIVEP-Gripe，一个全国性的严重急性呼吸道疾病入院患者监测数据库）中注册巴西的疾病），2020 年 2 月 16 日至 2021 年 1 月 9 日。主要结果是恢复（出院）或院内死亡的时间，通过使用累积发生率函数的竞争风险分析进行评估。

发现

在研究期间向 SIVEP-Gripe 报告的 82 055 名年龄小于 20 岁的患者中，11 613 名 (14·2%) 的可用数据显示实验室确认的 SARS-CoV-2 感染并被纳入样本。在这些患者中，886 例（7·6%）死于住院（入院后中位 6 天 [IQR 3–15]），10041 例（86·5%）患者出院，369 例（3·5%）患者出院2% 在分析时住院，317 (2·7%) 缺少结果信息。入院后前 10 天的估计死亡概率为 4·8%，前 20 天为 6·7%，随访结束时为 8·1%。前 10 天的出院概率为 54·1%，前 20 天的出院概率为 78·4%，随访结束时为 92·0%。我们的竞争风险多变量生存分析表明，2 岁以下婴儿（风险比 2·36 [95% CI 1·94–2·88]）或 12–19 岁青少年（2·23 [ 1·84–2·71]) 相对于 2–11 岁的儿童；土著种族 (3·36 [2·15–5·24]) 相对于白人种族的那些；居住在东北地区（2·06 [1·68–2·52]）或北部地区（1·55 [1·22–1·98]）与东南地区的人相比；以及具有一个 (2·96 [2·52–3·47])、两个 (4·96 [3·80–6·48]) 或三个或更多 (7·28 [4·56–11· 6]) 相对于那些没有的预先存在的医疗条件。土著种族 (3·36 [2·15–5·24]) 相对于白人种族的那些；居住在东北地区（2·06 [1·68–2·52]）或北部地区（1·55 [1·22–1·98]）与东南地区的人相比；以及具有一个 (2·96 [2·52–3·47])、两个 (4·96 [3·80–6·48]) 或三个或更多 (7·28 [4·56–11· 6]) 相对于那些没有的预先存在的医疗条件。土著种族 (3·36 [2·15–5·24]) 相对于白人种族的那些；居住在东北地区（2·06 [1·68–2·52]）或北部地区（1·55 [1·22–1·98]）与东南地区的人相比；以及具有一个 (2·96 [2·52–3·47])、两个 (4·96 [3·80–6·48]) 或三个或更多 (7·28 [4·56–11· 6]) 相对于那些没有的预先存在的医疗条件。

解释

COVID-19 的死亡与年龄、原住民种族、恶劣的地缘政治区域和既往疾病有关。医疗保健、贫困和合并症方面的差异可能会加剧巴西更脆弱和社会经济上处于不利地位的儿童和青少年的 COVID-19 负担。

资金

国家科学技术发展委员会，米纳斯吉拉斯州研究支持基金会。