Supervivencia en pacientes pediátricos con neumonía en enfermedad por coronavirus 2019 / Survival in pediatric patients with pneumonia in coronavirus disease 2019
Keywords:
Infecciones por coronavirus, Niño, Adolescente, Neumononía, Análisis de Supervivencia / Coronavirus Infections, Child, Adolescent, Pneumonia, Survival AnalysisAbstract
Resumen
Introducción: un segmento de niños y adolescentes con enfermedad por coronavirus 2019 (COVID-19) desarrollan neumonía y la evidencia publicada con relación a los factores pronósticos en esta población específica es escasa.
Objetivo: caracterizar la supervivencia de niños y adolescentes hospitalizados por neumonía relacionada con COVID-19, así como evaluar factores pronósticos del desenlace de la enfermedad.
Material y métodos: se hizo un estudio de tipo cohorte en México e información de niños y adolescentes hospitalizados por neumonía relacionada con COVID-19 fue analizada. Usamos el metódo de Kaplan-Meier para estimar funciones de supervivencia e intervalos de confianza del 95% (IC 95%), y modelos de regresión de riesgos proporcionales de Cox para evaluar la asociación de las exposiciones evaluadas con el desenlace de la enfermedad.
Resultados: se incluyeron un total de 1423 pacientes con un seguimiento de 15,188 días-persona y la tasa general de mortalidad hospitalaria (n = 208) fue 13.7 por 1000 días-persona. La función de supervivencia fue de 96.5% (IC 95% 95.2-97.4%) a 69.3% (IC 95% 63.9-74.0) a los tres y 30 días de estancia hospitalaria, respectivamente. En el análisis múltiple, el antecedente de inmunosupresión se asoció con un incremento en el riesgo de un desenlace fatal (cociente de riesgo [HR] = 2.70, IC 95% 1.38-5.30).
Conclusiones: caracterizamos la experiencia de supervivencia en una cohorte numerosa de niños y adolescentes con neumonía por COVID-19. Los hallazgos presentados sugieren que los menores de edad con antecedente de inmunosupresión y neumonía tienen un riesgo incrementado de un desenlace fatal.
Abstract
Background: A segment of children and adolescents with coronavirus disease 2019 (COVID-19) develops pneumonia and published evidence regarding its prognostic factors in this specific population is scarce.
Objective: To characterize the survival of children and adolescents hospitalized for pneumonia related to COVID-19, as well as to evaluate prognostic factors for disease’s outcomes.
Material and methods: A cohort study was performed in Mexico and data from hospitalized children and adolescents with COVID-19 related pneumonia were analyzed. We used the Kaplan-Meier method to estimate survival functions and 95% confidence intervals (95% CI), as well as Cox proportional-hazards regressions to evaluate the association of the evaluated exposures with the outcomes of disease.
Results: A total of 1423 patients were recruited for a follow-up of 15,188 person-days and the overall rate of in-hospital mortality (n = 208) was 13.7 per 1000 person-days. The survival function was 96.5% (95% CI 95.2-97.4%) and 69.3% (95% CI 63.9-74.0) of hospital stay, respectively. In multiple analysis, the history of immunosuppression was associated with an increased risk of a fatal outcome (hazard ratio [HR] = 2.70, IC 95% 1.38-5.30).
Conclusions: We characterized the survival of a large cohort of children and adolescents with COVID-19 related pneumonia. The presented findings suggest that minors with a history of immunosuppression and pneumonia have an increased risk of fatal outcome.
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