Pre-existing Immunocompromising Conditions and Outcomes of Acute COVID-19 Patients Admitted for Pediatric Intensive Care
Authors: Rowan Courtney M , LaBere Brenna , Young Cameron C , Zambrano Laura D , Newhams Margaret M , Kucukak Suden , McNamara Elizabeth R , Mack Elizabeth H , Fitzgerald Julie C , Irby Katherine , Maddux Aline B , Schuster Jennifer E , Kong Michele , Dapul Heda , Schwartz Stephanie P , Bembea Melania M , Loftis Laura L , Kolmar Amanda R , Babbitt Christopher J , Nofziger Ryan A , Hall Mark W , Gertz Shira J , Cvijanovich Natalie Z , Zinter Matt S , Halasa Natasha B , Bradford Tamara T , McLaughlin Gwenn E , Singh Aalok R , Hobbs Charlotte V , Wellnitz Kari , Staat Mary A , Coates Bria M , Crandall Hillary R , Maamari Mia , Havlin Kevin M , Schwarz Adam J , Carroll Christopher L , Levy Emily R , Moffitt Kristin L , Campbell Angela P , Randolph Adrienne G , Chou Janet ,   Overcoming COVID-19 Investigators, 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 
Published: March 2024

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 &lt;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 &lt;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.