Post-discharge outcomes of hospitalized children diagnosed with acute SARS-CoV-2 or MIS-C.

Autor:	Fink EL; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.; Safar Center for Resuscitation Research, University of Pittsburgh Medical Center, Pittsburgh, PA, United States., Alcamo AM; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States., Lovett M; Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States., Hartman M; Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA, United States., Williams C; Department of Pediatrics, Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR, United States., Garcia A; Division of Pediatric Physical Medicine and Rehabilitation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States., Rasmussen L; Division of Pediatric Critical Care Medicine, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, United States., Pal R; Department of Neurology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, United States., Drury K; Department of Pediatrics, Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR, United States.; Division of Pediatrics, Comer Children's Hospital, University of Chicago, Chicago, IL, United States., MackDiaz E; Division of Pediatric Critical Care Medicine, MUSC Shawn Jenkins Children's Hospital, Charleston, SC, United States., Ferrazzano PA; Department of Pediatrics, University of Wisconsin, Madison, WI, United States., Dervan L; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States., Appavu B; Division of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, College of Medicine, University of Arizona, Phoenix, AZ, United States., Snooks K; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States., Stulce C; Department of Pediatrics, University of Chicago, Chicago, IL, United States., Rubin P; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States., Pate B; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States., Toney N; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States., Robertson CL; Departments of Anesthesiology and Critical Care Medicine, and Pediatrics, Johns Hopkins Children's Center, Baltimore, MD, United States., Wainwright MS; Division of Pediatric Neurology, Seattle Children's Hospital, University of Washington, Seattle, WA, United States., Roa JD; Department of Pediatrics, Universidad Nacional de Colombia and Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia., Schober ME; Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States., Slomine BS; Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in pediatrics [Front Pediatr] 2024 Feb 12; Vol. 12, pp. 1340385. Date of Electronic Publication: 2024 Feb 12 (Print Publication: 2024).
DOI:	10.3389/fped.2024.1340385
Abstrakt:	Introduction: Hospitalized children diagnosed with SARS-CoV-2-related conditions are at risk for new or persistent symptoms and functional impairments. Our objective was to analyze post-hospital symptoms, healthcare utilization, and outcomes of children previously hospitalized and diagnosed with acute SARS-CoV-2 infection or Multisystem Inflammatory Syndrome in Children (MIS-C). Methods: Prospective, multicenter electronic survey of parents of children <18 years of age surviving hospitalization from 12 U.S. centers between January 2020 and July 2021. The primary outcome was a parent report of child recovery status at the time of the survey (recovered vs. not recovered). Secondary outcomes included new or persistent symptoms, readmissions, and health-related quality of life. Multivariable backward stepwise logistic regression was performed for the association of patient, disease, laboratory, and treatment variables with recovered status. Results: The children [ n  = 79; 30 (38.0%) female] with acute SARS-CoV-2 (75.7%) or MIS-C (24.3%) had a median age of 6.5 years (interquartile range 2.0-13.0) and 51 (64.6%) had a preexisting condition. Fifty children (63.3%) required critical care. One-third [23/79 (29.1%)] were not recovered at follow-up [43 (31, 54) months post-discharge]. Admission C-reactive protein levels were higher in children not recovered vs. recovered [5.7 (1.3, 25.1) vs. 1.3 (0.4, 6.3) mg/dl, p  = 0.02]. At follow-up, 67% overall had new or persistent symptoms. The most common symptoms were fatigue (37%), weakness (25%), and headache (24%), all with frequencies higher in children not recovered. Forty percent had at least one return emergency visit and 24% had a hospital readmission. Recovered status was associated with better total HRQOL [87 (77, 95) vs. 77 (51, 83), p  = 0.01]. In multivariable analysis, lower admission C-reactive protein [odds ratio 0.90 (95% confidence interval 0.82, 0.99)] and higher admission lymphocyte count [1.001 (1.0002, 1.002)] were associated with recovered status. Conclusions: Children considered recovered by their parents following hospitalization with SARS-CoV-2-related conditions had less symptom frequency and better HRQOL than those reported as not recovered. Increased inflammation and lower lymphocyte count on hospital admission may help to identify children needing longitudinal, multidisciplinary care. Clinical Trial Registration: ClinicalTrials.gov (NCT04379089). Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer MP-E declared a past co-authorship with the author LD to the handling editor. (© 2024 Fink, Alcamo, Lovett, Hartman, Williams, Garcia, Rasmussen, Pal, Drury, MackDiaz, Ferrazzano, Dervan, Appavu, Snooks, Stulce, Rubin, Pate, Toney, Robertson, Wainwright, Roa, Schober and Slomine.)
Databáze:	MEDLINE
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