Risk factors for poor prognosis in children and adolescents with COVID-19: A systematic review and meta-analysis.

Abstract

This study provides the first systematic review and meta-analysis to identify the predictors of unfavorable prognosis of COVID-19 in children and adolescents. We searched literature databases until July 2021 for studies that investigated risk factors for unfavorable prognosis of children and adolescents with COVID-19. We used random-effects models to estimate the effect size with 95% confidence interval (<i>CI</i>). We identified 56 studies comprising 79,104 individuals. Mortality was higher in patients with multisystem inflammatory syndrome (MIS-C) (odds ratio [<i>OR</i>]=58.00, 95% <i>CI</i> 6.39-526.79) and who were admitted to intensive care (<i>OR</i>=12.64, 95% <i>CI</i> 3.42-46.68). Acute respiratry distress syndrme (ARDS) (<i>OR</i>=29.54, 95% <i>CI</i> 12.69-68.78) and acute kidney injury (AKI) (<i>OR</i>=55.02, 95% <i>CI</i> 6.26-483.35) increased the odds to be admitted to intensive care; shortness of breath (<i>OR</i>=16.96, 95% <i>CI</i> 7.66-37.51) increased the need of respiratory support; and neurological diseases (<i>OR</i>=5.16, 95% <i>CI</i> 2.30-11.60), C-reactive protein (CRP) level ≥80 mg/L (<i>OR</i>=11.70, 95% <i>CI</i> 4.37-31.37) and D-dimer level ≥0.5ug/mL (<i>OR</i>=20.40, 95% <i>CI</i> 1.76-236.44) increased the odds of progression to severe or critical disease. Congenital heart disease, chronic pulmonary disease, neurological diseases, obesity, MIS-C, shortness of breath, ARDS, AKI, gastrointestinal symptoms, elevated CRP and D-dimer are associated with unfavourable prognosis in children and adolescents with COVID-19.