Risk factors for intensive care admission in pediatric patients with COVID-19 - results of the German na-tionwide inpatient sample
Authors: Keller K , Sagoschen I , Schmitt V H , Sivanathan V , Farmakis I T , Hahad O , Koelmel S , Schmidt F P , Espinola-Klein C , Konstantinides S , Munzel T , Lurz P , Hobohm L 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
In December 2019 first patient-cases of pneumonia caused by an unknown virus were detected in Wuhan, China. From this day on, SARS-CoV-2 spread throughout the world with an enormous pace causing the deadliest pandemic of the twenty-first century. First infection cases in Germany were reported at the end of January 2020 in Bavaria and sustained transmission of SARS-CoV-2 resulted also in Germany in a strong spread of COVID-19 in the population.
Although children and young people aged ≤18 years represent approximately 2%-5% of the SARS-CoV-2 cases globally, research efforts regarding COVID-19 pandemic have mainly focused on disease course of adults. Thus, early identification of children who must be monitored for life-threatening severe COVID-19 course remains difficult. Understanding of risk factors for ICU admission as one important bottleneck of adequate management regarding escalated treatment of COVID-19 pandemic is of outstanding interest to understand determinants, which are both crucial factors for adequate health care planning, decision making and pandemic management.

Purpose
We aimed to close this gap with identification of associated factors with pediatric ICU admissions in Germany.

Methods
We used the German nationwide inpatient sample analysing all hospitalised children ≤18 years with confirmed COVID-19 diagnosis in Germany between January 1st and December 31st, 2020 stratified fur ICU admission (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2020, own calculations).

Results
Overall, 3,360 cases of hospitalised children ≤18 years with COVID-19 infection were diagnosed in Germany 2020 (median age 7.0 [IQR 0.0-15.0] years, 49.8% of female sex); among them 4.3% had to be admitted on ICU. In-hospital death occurred in five patients with and three without ICU admission (3.5% vs. 0.1%, P&lt;0.001) and ICU admission was independently associated with increased case-fatality (OR 21.573 [95%CI 4.191-111.044], P&lt;0.001).
Obesity (OR 3.419 [95%CI 1.300-8.993], P=0.013), diabetes mellitus (OR 6.929 [95%CI 3.327-14.432], P&lt;0.001), pneumonia (OR 7.373 [95%CI 4.823-11.271], P&lt;0.001), ARDS (OR 48.058 [95%CI 11.689-197.588], P&lt;0.001) and multi-segmental Inflammatory syndrome caused by COVID-19 (OR 9.573 [95%CI 3.036-30.191], P&lt;0.001), heart failure (OR 64.509 [95%CI 24.462-170.121], P&lt;0.001), myocarditis (OR 4.682 [95%CI 1.278-17.149], P=0.020), acute and/or chronic kidney failure (OR 7.946 [95%CI 3.606-17.508], P&lt;0.001), cancer (OR 5.220 [95%CI 2.599-10.485], P&lt;0.001) and liver diseases (OR 5.501 [95%CI 2.177-13.899], P&lt;0.001) were associated with ICU admission.

Conclusions
The proportion of hospitalized paediatric COVID-19 patients admitted on ICU in Germany was low with 4.3% accompanied by 3.5% case-fatality rate. Independent factors for ICU admission comprised cardio-vascular risk factors, comorbidities and complications of COVID-19.