Factors Associated With Severe Gastrointestinal Diagnoses in Children With SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome
Authors: Andrea Lo Vecchio, Silvia Garazzino, Andrea Smarrazzo, Elisabetta Venturini, Marco Poeta, Paola Berlese, Marco Denina, Antonella Meini, Samantha Bosis, Luisa Galli, Salvatore Cazzato, Giangiacomo Nicolini, Gianluca Vergine, Roberta Giacchero, Giuseppina Ballardini, Icilio Dodi, Filippo Maria Salvini, Paolo Manzoni, Giuliana Ferrante, Vera Quadri, Andrea Campana, Raffaele Badolato, Alberto Villani, Alfredo Guarino, Guido Castelli Gattinara, Carlotta Montagnani, Luca Pierantoni, Andrzej Krzysztofiak, Daniele Donà, Sonia Bianchini, Elio Castagnola, Marcello Lanari, Emanuela Peschiaroli, Giovanni Corsello, Paola Marchisio, Federico Marchetti, Enrico Felici, Giulia Pruccoli, Caldarelli Valeria, Paolo Del Barba, Carlo Agostoni, Chiara Ghizzi, Sara Riscassi, Ivana Rabbone, Carmelina Calitri, Luisa Abbagnato, Luciana Parola, Giuseppe Banderali, Ilaria Pacati, Simonetta Cherubini, Paola Lippi, Andrea Guala, Rino Agostiniani, Ahmad Kantar, Luca Baroero, Nadia Rossi, Cristina Dalmazzo, Laura Panigati, Alessandro Vigo, Stefania Bezzio, Pasquale Comberiati, Giovanna Battezzati, Paola Verna, Gianluca Tornese, Francesca Poma, Luca Bertacca, Giorgio Zavarise, Luigi Marchione, Paola Gallia, Paola Di Filippo, Chiara Centenari, Alessandra Iacono, Alessandro Plebani, Marta Ferretti, Sara Rizzi, Sara Rossin, Alessandro De Fanti, Costantino De Giacomo, Graziano Barera, Roberta Pajno, Stefano Martelossi, Alessia Rocchi, Rosa Francavilla, Paola Sogno Valin, Piero Valentini, Anna Maria Magistà, Carolina Saffioti, Maria Cristina Greco, Paola Costenaro, Maria Di Pietro, Susanna Esposito, Giovanni Pieri, Maria Valentina Spartà, Valentina Maffini, Francesco Licciardi, Carlo Scolfaro, Giacomo Stera, Agostina Marolda, Lorenzo Fiorica, Caterina Sabatini, Maria Rita Genovese, Cristina Ferrari, Désirée Caselli, Francesco Chiarelli, Franco Di Lollo, Cesare Ghitti, Caterina Marabotto, Raffaele Papa, Laura Cursi, Sandra Trapani, Anna Elisabetta Bussolini
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Severe gastrointestinal (GI) manifestations have been sporadically reported in children with COVID-19; however, their frequency and clinical outcome are unknown. <h3>Objective</h3> To describe the clinical, radiological, and histopathologic characteristics of children with COVID-19 presenting with severe GI manifestations to identify factors associated with a severe outcome. <h3>Design, Setting, and Participants</h3> A multicenter retrospective cohort study (February 25, 2020, to January 20, 2021) enrolled inpatient and outpatient children (aged &lt;18 years) with acute SARS-CoV-2 infection, confirmed by positive real-time reverse-transcriptase–polymerase chain reaction on nasopharyngeal swab or fulfilling the US Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children (MIS-C). The study was conducted by pediatricians working in primary care or hospitals in Italy participating in the COVID-19 Registry of the Italian Society of Pediatric Infectious Diseases. <h3>Main Outcomes and Measures</h3> The occurrence of severe GI manifestations, defined by a medical and/or radiological diagnosis of acute abdomen, appendicitis (complicated or not by perforation and/or peritonitis), intussusception, pancreatitis, abdominal fluid collection, and diffuse adenomesenteritis requiring surgical consultation, occurring during or within 4 to 6 weeks after infection with SARS-CoV-2 infection. Logistic regression was used to estimate odds ratios (ORs) with 95% CIs of factors potentially associated with severe outcomes. <h3>Results</h3> Overall, 685 children (386 boys [56.4%]; median age, 7.3 [IQR, 1.6-12.4] years) were included. Of these children, 628 (91.7%) were diagnosed with acute SARS-CoV-2 infection and 57 (8.3%) with MIS-C. The presence of GI symptoms was associated with a higher chance of hospitalization (OR, 2.64; 95% CI, 1.89-3.69) and intensive care unit admission (OR, 3.90; 95% CI, 1.98–7.68). Overall, 65 children (9.5%) showed severe GI involvement, including disseminated adenomesenteritis (39.6%), appendicitis (33.5%), abdominal fluid collection (21.3%), pancreatitis (6.9%), or intussusception (4.6%). Twenty-seven of these 65 children (41.5%) underwent surgery. Severe GI manifestations were associated with the child's age (5-10 years: OR, 8.33; 95% CI, 2.62-26.5; &gt;10 years: OR, 6.37; 95% CI, 2.12-19.1, compared with preschool-age), abdominal pain (adjusted OR [aOR], 34.5; 95% CI, 10.1-118), lymphopenia (aOR, 8.93; 95% CI, 3.03-26.3), or MIS-C (aOR, 6.28; 95% CI, 1.92-20.5). Diarrhea was associated with a higher chance of adenomesenteritis (aOR, 3.13; 95% CI, 1.08-9.12) or abdominal fluid collection (aOR, 3.22; 95% CI, 1.03-10.0). <h3>Conclusions and Relevance</h3> In this multicenter cohort study of Italian children with SARS-CoV-2 infection or MIS-C, 9.5% of the children had severe GI involvement, frequently associated with MIS-C. These findings suggest that prompt identification may improve the management of serious complications.