Table1_Risk factors for health impairments in children after hospitalization for acute COVID-19 or MIS-C.docx

ObjectiveTo identify risk factors for persistent impairments after pediatric hospitalization for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C) during the SARS-CoV-2 pandemic.
MethodsAcross 25 U.S. Overcoming COVID-19 Network hospitals, we conducted a prospective cohort study of patients <21-years-old hospitalized for acute COVID-19 or MIS-C (May 2020 to March 2022) surveyed 2- to 4-months post-admission. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI).
ResultsOf 232 children with acute COVID-19, 71 (30.6%) had persistent symptoms and 50 (21.6%) had activity impairments at follow-up; for MIS-C (n = 241), 56 (23.2%) had persistent symptoms and 58 (24.1%) had activity impairments. In adjusted analyses of patients with acute COVID-19, receipt of mechanical ventilation was associated with persistent symptoms [aRR 1.83 (95% CI: 1.07, 3.13)] whereas obesity [aRR 2.18 (95% CI: 1.05, 4.51)] and greater organ system involvement [aRR 1.35 (95% CI: 1.13, 1.61)] were associated with activity impairment. For patients with MIS-C, having a pre-existing respiratory condition was associated with persistent symptoms [aRR 3.04 (95% CI: 1.70, 5.41)] whereas obesity [aRR 1.86 (95% CI: 1.09, 3.15)] and greater organ system involvement [aRR 1.26 (1.00, 1.58)] were associated with activity impairments.
DiscussionAmong patients hospitalized, nearly one in three hospitalized with acute COVID-19 and one in four hospitalized with MIS-C had persistent impairments for ≥2 months post-hospitalization. Persistent impairments were associated with more severe illness and underlying health conditions, identifying populations to target for follow-up.

研究目的：明确在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行期间，因新型冠状病毒肺炎（COVID-19）或儿童多系统炎症综合征（MIS-C）住院的儿科患者，其出院后持续存在功能损害的危险因素。

研究方法：本研究依托美国25家「克服COVID-19网络（Overcoming COVID-19 Network）」医院，针对2020年5月至2022年3月期间因急性COVID-19或MIS-C住院的21岁以下患者开展前瞻性队列研究，于患者入院后2~4个月进行随访调查。采用多变量回归（multivariable regression）分析计算校正后风险比（aRR）及95%置信区间（CI）。

研究结果：在232例急性COVID-19患儿中，71例（30.6%）随访时存在持续症状，50例（21.6%）存在活动功能障碍；在241例MIS-C患儿中，56例（23.2%）存在持续症状，58例（24.1%）存在活动功能障碍。针对急性COVID-19患儿的校正分析显示，接受机械通气（mechanical ventilation）与持续症状存在关联[aRR=1.83, 95%CI: 1.07~3.13]；而肥胖[aRR=2.18, 95%CI: 1.05~4.51]及更多器官系统受累[aRR=1.35, 95%CI: 1.13~1.61]与活动功能障碍相关。针对MIS-C患儿，合并基础呼吸系统疾病与持续症状存在关联[aRR=3.04, 95%CI: 1.70~5.41]；而肥胖[aRR=1.86, 95%CI: 1.09~3.15]及更多器官系统受累[aRR=1.26, 95%CI: 1.00~1.58]与活动功能障碍相关。

讨论：本研究纳入的住院患儿中，近1/3因急性COVID-19住院的患儿、1/4因MIS-C住院的患儿，在出院后≥2个月仍存在持续功能损害。持续功能损害与疾病严重程度更高及基础健康状况异常相关，该结果可用于识别需要重点随访的人群。