Predictors associated with critical care need and in-hospital mortality among children with laboratory-confirmed Covid-19 infection in a high HIV burden region

Abstract

Introduction: Despite the extra mortality associated with Covid-19 death globally, little is known on COVID-19-related pediatric mortality in Africa. We assessed predictors of critical care needs and in-hospital mortality in South African children with laboratory-confirmed SARS-CoV-2 infection.

Methods: A secondary analysis of AFREhealth cohort children (large cohort of paediatric Covid-19 clinical outcomes across six African countries) admitted to Inkosi-Albert-Luthuli hospital, KwaZulu-Natal, South Africa. We used multivariable logistic regression and cox-proportional hazards models to explore predictors for intensive care and in-hospital death.

Results: Of the 82 children with PCR-confirmed SARS-CoV-2 infection, 35(42.7%) were younger than one year and 59(71%) had a comorbidity. 37(45.2%) children required critical care and 14(17%) died. Significant predictors of critical care need were age≤1year (vs.10-12years)(aOR:5.38,95%CI:1.28-22.54,p=0.02), ≥1comorbidity (aOR:6.62,95%CI:1.49-29.53,p=0.01) and increase in blood urea nitrogen/BUN (aOR:1.53,95%CI:1.13-2.07,p=0.001). HIV-infection (aHR:8.46,95%CI:1.45-49.26,p=0.02), invasive ventilation (aHR:3.59,95%CI:1.01-12.16,p=0.0.048), and BUN (aHR:1.06,95%CI:1.01-1.11,p=0.017) predicted death. Children admitted primarily (vs referred)to a quaternary hospital were less likely to die.

Conclusion: Children with Covid-19 have a significant hospital death rate. A timely referral system and triage of children at risk for critical care and death, like those under 1 year and with comorbidities, should minimize excess mortality, especially in high HIV-infection burden regions.