Risk factors for post-COVID-19 condition in previously hospitalised children using the ISARIC Global follow-up protocol: a prospective cohort study

  1. Ismail M. Osmanov
  2. Ekaterina Spiridonova
  3. Polina Bobkova
  4. Aysylu Gamirova
  5. Anastasia Shikhaleva
  6. Margarita Andreeva
  7. Oleg Blyuss
  8. Yasmin El-Taravi
  9. Audrey DunnGalvin
  10. Pasquale Comberiati
  11. Diego G. Peroni
  12. Christian Apfelbacher
  13. Jon Genuneit
  14. Lyudmila Mazankova
  15. Alexandra Miroshina
  16. Evgeniya Chistyakova
  17. Elmira Samitova
  18. Svetlana Borzakova
  19. Elena Bondarenko
  20. Anatoliy A. Korsunskiy
  21. Irina Konova
  22. Sarah Wulf Hanson
  23. Gail Carson
  24. Louise Sigfrid
  25. Janet T. Scott
  26. Matthew Greenhawt
  27. Elizabeth A. Whittaker
  28. Elena Garralda
  29. Olivia V. Swann
  30. Danilo Buonsenso
  31. Dasha E. Nicholls
  32. Frances Simpson
  33. Christina Jones
  34. Malcolm G. Semple
  35. John O. Warner
  36. Theo Vos
  37. Piero Olliaro
  38. Daniel Munblit

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Abstract

The long-term sequelae of coronavirus disease 2019 (COVID-19) in children remain poorly characterised. This study aimed to assess long-term outcomes in children previously hospitalised with COVID-19 and associated risk factors.

Methods

This is a prospective cohort study of children (≤18 years old) admitted to hospital with confirmed COVID-19. Children admitted between 2 April 2020 and 26 August 2020 were included. Telephone interviews used the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 Health and Wellbeing Follow-up Survey for Children. Persistent symptoms (>5 months) were further categorised by system(s) involved.

Results

518 out of 853 (61%) eligible children were available for the follow-up assessment and included in the study. Median (interquartile range (IQR)) age was 10.4 (3–15.2) years and 270 (52.1%) were girls. Median (IQR) follow-up since hospital discharge was 256 (223–271) days. At the time of the follow-up interview 126 (24.3%) participants reported persistent symptoms, among which fatigue (53, 10.7%), sleep disturbance (36, 6.9%) and sensory problems (29, 5.6%) were the most common. Multiple symptoms were experienced by 44 (8.4%) participants. Risk factors for persistent symptoms were: older age “6–11 years” (OR 2.74, 95% CI 1.37–5.75) and “12–18 years” (OR 2.68, 95% CI 1.41–5.4), and a history of allergic diseases (OR 1.67, 95% CI 1.04–2.67).

Conclusions

A quarter of children experienced persistent symptoms months after hospitalisation with acute COVID-19 infection, with almost one in 10 experiencing multisystem involvement. Older age and allergic diseases were associated with higher risk of persistent symptoms at follow-up.

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  1. Version published to 10.1183/13993003.01341-2021
  2. ScreenIT

    SciScore for 10.1101/2021.04.26.21256110: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: This study was approved by the Moscow City Independent Ethics Committee (abbreviate 1, protocol number 74).
    Consent: Parental consent was sought during hospital admission and consent for the follow-up interview was sought via verbal confirmation during telephone interview.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data management: REDCap electronic data capture tools (Vanderbilt University, Nashville, TN, USA) hosted at Sechenov University and Microsoft Excel (Microsoft Corp, Redmond, WA, USA) were used for data collection, storage and management 20,21.
    REDCap
    suggested: (REDCap, RRID:SCR_003445)
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A limitation of these findings is that symptom onset and duration was recalled at the single follow-up interview in our study; this may be overcome with repeated follow-ups at appropriate intervals to limit potential recall imprecision. In line with our results, previous research demonstrated symptoms fading over time in adults 22 but data are still limited as most of the published cohort studies do not measure symptom duration, but rather assess their presence at a single follow-up. We found that almost one in ten children had multisystem impacts with two or more categories of persistent symptoms present at the time of the follow-up. Similar numbers were previously reported in the Russian adult population 3 and patients with clusters of different symptoms were described in the UK 28. Patients with multisystem involvement will represent the primary target for the future research and intervention strategies development. Age was significantly associated with persistent symptom presence at the time of the follow-up, with children above 6 years of age being at higher risk. To our knowledge, risk factors for long Covid in children have not been investigated in previous studies, so we may draw comparisons with the data from adult cohorts only. Previous data suggest that long Covid is prevalent in adults 2,3,28-31 and that age is associated with a higher risk of long Covid 28,30. An Australian follow-up study of 151 children aged 0-19 years (median 3 years) who had predominantly mil...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.04.26.21256110v1 on medRxiv