Gastrointestinal Manifestations Are Associated with Severe COVID-19 in Children
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Population
2.2. Inclusion Criteria
2.3. Data Collection
2.4. Outcomes
2.5. Statistical Analysis
3. Results
3.1. Hospital vs. Non-Hospital Groups
3.2. ICU vs. Floor Groups
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
BMI | Body mass index |
CI | Confidence interval |
COVID-19 | Coronavirus disease 2019 |
EHR | Electronic health record |
ICU | Intensive care unit |
IQR | Interquartile range |
OR | Odds ratio |
OSA | Obstructive sleep apnea |
SARS-CoV-2 | Severe acute respiratory syndrome coronavirus 2 |
PCR | Polymerase chain reaction |
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Demographics | All (n = 253) | Nonhospital (n = 184) | Hospital (n = 69) | Crude OR (95% CI) | p Value |
---|---|---|---|---|---|
Age (year), median (IQR) | 6.8 (0.8–13.6) | 6.1 (0.8–13.5) | 9.5 (1.8–13.7) | 0.11 | |
Female, n (%) | 132 (52) | 95 (52) | 37 (54) | 1.08 (0.62–1.89) | 0.78 |
Race/Ethnicity, n (%) | |||||
Black—non-Hispanic | 39 (15) | 23 (13) | 16 (23) | 1.79 (0.61–5.27) | 0.19 |
White—non-Hispanic | 25 (10) | 18 (10) | 7 (10) | Ref | |
Other—non-Hispanic | 11 (4) | 9 (5) | 2 (3) | 0.57 (0.10–3.33) | |
Hispanic | 178 (70) | 134 (73) | 44 (64) | 0.84 (0.33–2.16) | |
Underlying medical conditions, n (%) | |||||
Any | 89 (35) | 50 (27) | 39 (57) | 3.48 (1.96–6.20) | <0.001 |
Preterm birth | 12 (5) | 9 (5) | 3 (4) | 0.88 (0.23–3.36) | 0.86 |
Pulmonary | 45 (18) | 28 (15) | 17 (25) | 1.82 (0.92–3.59) | 0.08 |
Asthma | 31 (12) | 22 (12) | 9 (13) | 1.10 (0.48–2.53) | 0.81 |
OSA | 10 (4) | 3 (2) | 7 (10) | 6.81 (1.71–27.16) | 0.007 |
Cardiac | 9 (4) | 6 (3) | 3 (4) | 1.34 (0.33–5.55) | 0.68 |
Congenital heart disease | 4 (1) | 2 (1) | 2 (3) | 2.72 (0.38–19.67) | 0.32 |
Hypertension | 7 (3) | 1 (1) | 6 (9) | 17.4 (2.06–147.6) | 0.009 |
Renal | 10 (4) | 5 (3) | 5 (7) | 2.80 (0.78–9.98) | 0.11 |
Chronic kidney disease | 4 (1) | 2 (1) | 2 (3) | 2.72 (0.38–19.67) | 0.32 |
Gastrointestinal | 14 (6) | 6 (3) | 8 (12) | 3.89 (1.30–11.66) | 0.02 |
Hematologic | 9 (3) | 4 (2) | 4 (6) | 2.77 (0.67–11.40) | 0.16 |
Sickle cell disease | 5 (2) | 1 (1) | 4 (6) | 11.3 (1.24–102.6) | 0.03 |
Seizure disorder | 17 (6) | 5 (3) | 9 (13) | 5.37 (1.73–16.65) | 0.004 |
Neurodevelopmental disorders | 19 (8) | 10 (5) | 9 (13) | 2.61 (1.01–6.73) | 0.05 |
Diabetes mellitus | 5 (2) | 0 | 5 (7) | n/a | n/a |
Immunocompromised | |||||
Cancer | 6 (2) | 2 (1) | 4 (6) | 5.69 (1.02–31.80) | 0.05 |
BMT | 2 (1) | 0 | 2 (3) | n/a | n/a |
Other immunodeficiency | 8 (3) | 3 (2) | 5 (7) | 4.71 (1.10–20.29) | 0.04 |
SOT | 3 (1) | 1 (1) | 2 (3) | 5.46 (0.49–61.23) | 0.17 |
Symptoms at presentation, n (%) | |||||
Fever | 171 (68) | 131 (80) | 40 (58) | 0.56 (0.31–0.99) | 0.05 |
Anosmia | 15 (6) | 11 (6) | 4 (6) | 0.97 (0.30–3.15) | 0.96 |
Dysgeusia | 12 (5) | 8 (4) | 4 (6) | 1.35 (0.39–4.65) | 0.63 |
Rash | 14 (6) | 10 (5) | 4 (6) | 1.07 (0.32–3.53) | 0.91 |
Cough | 99 (39) | 79 (48) | 20 (29) | 0.54 (0.30–0.98) | 0.04 |
SOB | 35 (14) | 24 (13) | 11 (16) | 1.26 (0.58–2.74) | 0.55 |
Sore throat | 44 (17) | 39 (21) | 5 (7) | 0.29 (0.11–0.77) | 0.01 |
Rhinorrhea | 46 (18) | 41 (22) | 5 (7) | 0.27 (0.10–0.72) | 0.009 |
Headache | 45 (18) | 36 (20) | 9 (13) | 0.62 (0.28–1.36) | 0.23 |
Myalgia | 17 (7) | 12 (7) | 5 (7) | 1.12 (0.38–3.30) | 0.84 |
Diarrhea | 36 (14) | 27 (15) | 9 (13) | 0.87 (0.39–1.96) | 0.74 |
Nausea/vomiting | 71 (28) | 46 (25) | 25 (36) | 1.70 (0.94–3.09) | 0.08 |
Abdominal pain | 41 (16) | 24 (13) | 17 (24) | 2.18 (1.09–4.37) | 0.03 |
Demographics | Floor (n = 54) | ICU (n = 15) | Crude OR (95% CI) | p Value |
---|---|---|---|---|
Age (year), median (IQR) | 9 (0–14) | 9 (5.5–12.5) | 0.69 | |
Female, n (%) | 31 (57) | 6 (40) | 0.49 (0.15–1.59) | 0.24 |
Race/Ethnicity, n (%) | ||||
Black—non-Hispanic | 12 (22) | 4 (27) | 0.44 (0.07–2.90) | 0.17 |
White—non-Hispanic | 4 (7) | 7 (10) | Ref | |
Other—non-Hispanic | 1 (2) | 2 (3) | 1.33 (0.57–31.1) | |
Hispanic | 37 (69) | 44 (64) | 0.25 (0.05–1.38) | |
BMI, median (IQR) | 20.4 (16.9–23.8) | 19.9 (15.8–21.4) | 0.34 | |
Underlying medical conditions, n (%) | ||||
Any | 28 (52) | 11 (73) | 2.55 (0.72–9.03) | 0.15 |
Preterm birth | 2 (4) | 1 (7) | 1.86 (0.16–22.00) | 0.62 |
Pulmonary | 10 (19) | 7 (47) | 3.85 (1.13–13.10) | 0.03 |
Asthma | 6 (11) | 3 (20) | 2.00 (0.44–9.18) | 0.37 |
OSA | 2 (4) | 5 (33) | 13.00 (2.21–76.63) | <0.001 |
Cardiac | 3 (6) | 0 | n/a | n/a |
Congenital heart disease | 2 (4) | 0 | n/a | n/a |
Hypertension | 5 (9) | 1 (7) | 0.70 (0.08–6.49) | 0.75 |
Renal | 4 (8) | 1 (7) | 0.89 (0.09–8.64) | 0.92 |
Chronic kidney disease | 2 (4) | 0 | n/a | n/a |
Gastrointestinal | 3 (6) | 5 (33) | 8.50 (1.74–41.42) | 0.008 |
G tube dependence | 0 | 4 (27) | n/a | n/a |
Sickle cell disease | 2 (4) | 2 (14) | 4.00 (0.51–31.13) | 0.19 |
Neurologic | ||||
Seizure disorder | 3 (6) | 6 (40) | 11.33 (2.39–53.75) | 0.002 |
Neurodevelopmental disorders | 4 (8) | 5 (33) | 6.25 (1.42–27.45) | <0.001 |
Diabetes mellitus | 4 (7) | 1 (7) | 0.89 (0.09–8.64) | 0.92 |
Immunocompromised | ||||
Cancer | 3 (6) | 1 (7) | 1.19 (0.11–12.35) | 0.88 |
BMT | 0 | 2 (14) | n/a | n/a |
Other immunodeficiency | 4 (7) | 1 (7) | 0.89 (0.09–8.64) | 0.92 |
SOT | 2 (4) | 0 | n/a | n/a |
Symptoms at presentation, n (%) | ||||
Fever | 31 (57) | 9 (60) | 1.11 (0.35–3.57) | 0.86 |
Anosmia | 4 (7) | 0 | n/a | n/a |
Dysgeusia | 4 (7) | 0 | n/a | n/a |
Rash | 3 (6) | 1 (7) | 1.21 (0.12–12.60) | 0.87 |
Cough | 13 (24) | 7 (47) | 2.76 (0.84–9.08) | 0.10 |
SOB | 3 (6) | 8 (53) | 19.43 (4.15–91.01) | <0.001 |
Sore throat | 4 (7) | 1 (7) | 0.89 (0.09–8.64) | 0.92 |
Rhinorrhea | 4 (7) | 1 (7) | 0.89 (0.09–8.64) | 0.92 |
Headache | 6 (11) | 3 (20) | 2.00 (0.44–9.18) | 0.37 |
Myalgia | 3 (6) | 2 (13) | 2.62 (0.40–17.31) | 0.32 |
Diarrhea | 3 (6) | 6 (40) | 11.33 (2.39–53.75) | 0.002 |
Nausea/vomiting | 19 (35) | 6 (40) | 1.23 (0.38–3.97) | 0.73 |
Abdominal pain | 14 (25) | 3 (20) | 0.71 (0.18–2.91) | 0.64 |
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Akkoyun, E.B.; Ashraf, B.; Hanners, N.; Kahn, J.; Most, Z. Gastrointestinal Manifestations Are Associated with Severe COVID-19 in Children. Healthcare 2024, 12, 81. https://doi.org/10.3390/healthcare12010081
Akkoyun EB, Ashraf B, Hanners N, Kahn J, Most Z. Gastrointestinal Manifestations Are Associated with Severe COVID-19 in Children. Healthcare. 2024; 12(1):81. https://doi.org/10.3390/healthcare12010081
Chicago/Turabian StyleAkkoyun, Esra Betul, Bilal Ashraf, Natasha Hanners, Jeffrey Kahn, and Zachary Most. 2024. "Gastrointestinal Manifestations Are Associated with Severe COVID-19 in Children" Healthcare 12, no. 1: 81. https://doi.org/10.3390/healthcare12010081