151 - Preexisting Chronic Illness as a Risk Factor for Pediatric COVID-19 Disease Severity

Poster Number: 151
Publication Number: 151.305

Ryan Handoko, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Teresa PY Chiang, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Dorry Segev, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Allan B. Massie, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Olga Charnaya, Johns Hopkins University School of Medicine, Baltimore, MD, United States

Background: Some children experience severe disease and long-term complications from acute COVID-19 infection. Risk factors for hospitalization and increased severity of COVID-19-related illness have not been consistent across studies and may include age, obesity, and preexisting chronic illness.

Objective: We sought to investigate whether underlying chronic illness, in addition to age and obesity, was a risk factor for severe COVID-19 clinical course among pediatric patients.

Design/Methods: We utilized the COVID-19 Precision Medicine Analytics Platform Registry, an EMR-based data source. This identified hospitalizations of COVID-19 positive pediatric patients ages 0-21 years (n = 258) from across all Johns Hopkins institutions in Maryland, District of Columbia, and Florida. Preexisting chronic illnesses were identified through ICD10 billing codes and verified by manual chart review. Hospitalization course was categorized according to the WHO ordinal scale for clinical improvement (WHO score). Severe hospitalizations were defined as those that attained a WHO score ≥ 5. A Fine-Gray competing risk model was used to compare time to severe illness or hospital discharge.

Results: Children with severe COVID were more likely to be younger [median (IQR) 5.5 (1-15.5) vs 14.5 (2-19) years, p = 0.027]. BMI, smoking status, and history of asthma did not differ between the groups (Table 1). Children with severe COVID were more likely to have chronic GI illness, chronic lung disease, seizures, genetic conditions, congenital malformations, developmental delay, and cardiovascular disease. Compared to previous healthy children, those with chronic medical conditions reached statistically significantly higher WHO scores [median (IQR) 5 (5-6) vs 3 (3-3), p < 0.001, Figure 1].  Children with underlying chronic illness had longer length of stay [4 (2-9) vs 2 (1-5) days, p < 0.001] and faster progression to severe disease (sHR 2.3, 95% CI 1.3-4.1, p = 0.003, Figure 2). Conclusion(s): Children with certain underlying chronic medical conditions are at higher risk for severe COVID-19 infection with adverse clinical outcomes. We did not identify asthma, obesity and adolescent age as risk factors for severe infection. In our cohort, children with preexisting GI, lung, seizure, genetic, and cardiovascular conditions are at increased risk for severe COVID-19 infection and may require increased respiratory support and longer hospitalizations.
Ryan Handoko - CV.pdf
Figure 1Mean Score of WHO Ordinal Scale by Day of Hospitalization in Children with and without Chronic Medical Conditions