Pre-existing Immunocompromising Conditions and Outcomes of Acute COVID-19 Patients Admitted for Pediatric Intensive Care

Author:

Rowan Courtney M1ORCID,LaBere Brenna23,Young Cameron C4,Zambrano Laura D5,Newhams Margaret M4,Kucukak Suden4,McNamara Elizabeth R4,Mack Elizabeth H6,Fitzgerald Julie C7,Irby Katherine8,Maddux Aline B9,Schuster Jennifer E10,Kong Michele11,Dapul Heda12,Schwartz Stephanie P13,Bembea Melania M14,Loftis Laura L15,Kolmar Amanda R16,Babbitt Christopher J17,Nofziger Ryan A18,Hall Mark W19,Gertz Shira J20,Cvijanovich Natalie Z21,Zinter Matt S22,Halasa Natasha B23,Bradford Tamara T24,McLaughlin Gwenn E25,Singh Aalok R26,Hobbs Charlotte V27,Wellnitz Kari28,Staat Mary A29,Coates Bria M30,Crandall Hillary R31,Maamari Mia32,Havlin Kevin M33,Schwarz Adam J34,Carroll Christopher L35,Levy Emily R36,Moffitt Kristin L37,Campbell Angela P5,Randolph Adrienne G438ORCID,Chou Janet2, ,Kong Michele,Gaspers Mary Glas,Typpo Katri V,Sanders Ronald C,Irby Katherine,Schwarz Adam J,Babbitt Christopher J,Pannaraj Pia S,Harvey Helen,Cvijanovich Natalie Z,Zinter Matt S,Maddux Aline B,Port Emily,Shankman Sara,Mansour Rachel,Carroll Christopher L,Giuliano John S,McLaughlin Gwenn E,Espinal Paula S,Tarquinio Keiko M,Michelson Kelly N,Coates Bria M,Rowan Courtney M,Wellnitz Kari,Bhoojhawon Guru,Sullivan Janice E,Montgomery Vicki L,Havlin Kevin M,Bradford Tamara T,Bembea Melania M,Graciano Ana Lia,Randolph Adrienne G,Newhams Margaret M,Chen Sabrina R,Young Cameron C,Kucukak Suden,Son Mary Beth F,Chou Janet S,LaBere Brenna,Carroll Ryan W,Yager Phoebe H,Fernandes Neil D,Flori Heidi R,Hume Janet R,Levy Emily R,Johnson Brandi A,Drapeau Noelle M,Behl Supriya,Hobbs Charlotte V,Malloch Lacy,Martin Lora,McGraw Sarah,Schuster Jennifer E,Spinella Philip C,Kolmar Amanda R,Cullimore Melissa L,McCulloh Russell J,Clouser Katharine N,Gertz Shira J,Kleinman Lawrence C,Li Simon,Horwitz Steven M,Kuebler Joseph,Singh Aalok R,Ratner Adam J,Dapul Heda,Soma Vijaya L,Biagas Katherine V,Doymaz Sule,Schwartz Stephanie P,Walker Tracie C,Shein Steven L,Lansell Amanda N,Hall Mark W,Nofziger Ryan A,Staat Mary Allen,Fitzgerald Julie C,Burnett Ryan H,Bush Jenny L,Thomas Neal J,Fink Ericka L,Carcillo Joseph A,Butler Andrew,Mack Elizabeth H,Reed Nelson,Halasa Natasha B,Stewart Laura,Golchha Meena,Loftis Laura L,Samperio Marian,Munoz Alvaro Coronado,Qurashi Jacob,Bowens Cindy,Maamari Mia,Crandall Hillary,Smith Lincoln S,McGuire John K

Affiliation:

1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children , Indianapolis, Indiana , USA

2. Division of Immunology, Boston Children's Hospital, Harvard Medical School , Boston, Massachusetts , USA

3. Division of Pulmonology, Section of Allergy–Immunology, Phoenix Children's Hospital , Phoenix, Arizona , USA

4. Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital , Boston, Massachusetts , USA

5. Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention , Atlanta, Georgia , USA

6. Division of Pediatric Critical Care Medicine, Medical University of South Carolina , Charleston, South Carolina , USA

7. Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania , USA

8. Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital , Little Rock, Arkansas , USA

9. Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, Colorado , USA

10. Division of Pediatric Infectious Disease, Department of Pediatrics, Children's Mercy Kansas City , Kansas City, Missouri , USA

11. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham , Birmingham, Alabama , USA

12. Division of Pediatric Critical Care Medicine, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital at NYU Langone , New York, New York , USA

13. Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital , Chapel Hill, North Carolina , USA

14. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA

15. Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine , Houston, Texas , USA

16. Department of Pediatrics, Washington University in St. Louis , St. Louis, Missouri , USA

17. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Miller Children's and Women's Hospital of Long Beach , Long Beach, California , USA

18. Division of Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital , Akron, Ohio , USA

19. Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital , Columbus, Ohio , USA

20. Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center , Livingston, New Jersey , USA

21. Division of Critical Care Medicine, UCSF Benioff Children's Hospital Oakland , Oakland, California , USA

22. Department of Pediatrics, Divisions of Critical Care Medicine and Allergy, Immunology, and Bone Marrow Transplant, University of California San Francisco , San Francisco, California , USA

23. Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center , Nashville, Tennessee , USA

24. Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans , New Orleans, Louisiana , USA

25. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Miami Miller School of Medicine , Miami, Florida , USA

26. Pediatric Critical Care Division, Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College , Valhalla, New York , USA

27. Department of Pediatrics, Division of Infectious Diseases, Department of Cell and Molecular Biology, University of Mississippi Medical Center , Jackson, Mississippi , USA

28. Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine , Iowa City, Iowa , USA

29. Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio , USA

30. Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois , USA

31. Division of Pediatric Critical Care, Department of Pediatrics, University of Utah and Primary Children's Hospital , Salt Lake City, Utah , USA

32. Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children's Medical Center Dallas, Dallas, Texas , USA

33. Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Louisville, and Norton Children's Hospital , Louisville, Kentucky , USA

34. Division of Critical Care Medicine, Children's Health Orange County (CHOC) , Orange, California , USA

35. Division of Critical Care, Connecticut Children's Medical Center , Hartford, Connecticut , USA

36. Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic , Rochester, Minnesota , USA

37. Division of Infectious Diseases, Boston Children's Hospital , Boston, Massachusetts , USA

38. Departments of Anaesthesia and Pediatrics, Harvard Medical School , Boston, Massachusetts , USA

Abstract

Abstract Background We aimed to determine if pre-existing immunocompromising conditions (ICCs) were associated with the presentation or outcome of patients with acute coronavirus disease 2019 (COVID-19) admitted for pediatric intensive care. Methods Fifty-five hospitals in 30 US states reported cases through the Overcoming COVID-19 public health surveillance registry. Patients <21 years admitted 12 March 2020–30 December 2021 to the pediatric intensive care unit (PICU) or high-acuity unit for acute COVID-19 were included. Results Of 1274 patients, 105 (8.2%) had an ICC, including 33 (31.4%) hematologic malignancies, 24 (22.9%) primary immunodeficiencies and disorders of hematopoietic cells, 19 (18.1%) nonmalignant organ failure with solid-organ transplantation, 16 (15.2%) solid tumors, and 13 (12.4%) autoimmune disorders. Patients with ICCs were older, had more underlying renal conditions, and had lower white blood cell and platelet counts than those without ICCs, but had similar clinical disease severity upon admission. In-hospital mortality from COVID-19 was higher (11.4% vs 4.6%, P = .005) and hospitalization was longer (P = .01) in patients with ICCs. New major morbidities upon discharge were not different between those with and without ICC (10.5% vs 13.9%, P = .40). In patients with ICCs, bacterial coinfection was more common in those with life-threatening COVID-19. Conclusions In this national case series of patients <21 years of age with acute COVID-19 admitted for intensive care, existence of a prior ICCs were associated with worse clinical outcomes. Reassuringly, most patients with ICCs hospitalized in the PICU for severe acute COVID-19 survived and were discharged home without new severe morbidities.

Funder

US Centers for Disease Control and Prevention

National Institutes of Health

Publisher

Oxford University Press (OUP)

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