19住院儿童和青少年的临床特征分析
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19住院儿童和青少年的临床特征分析添加时间:2020-08-31

本期文章:《英国医学杂志》:Online/在线发表

英国利物浦大学Malcolm G Semple团队对covid-19住院的儿童和青少年的临床特征进行了分析。2020年8月27日,《英国医学杂志》发表了该成果。

为了研究英国实验室确诊的SARS-CoV-2感染住院的儿童和青少年的临床特征,并探讨接受重症监护、死亡和儿童青少年covid-19相关多系统炎性综合征(MIS-C)的危险因素,2020年1月17日至7月3日,研究组在英格兰、威尔士和苏格兰的260家医院进行了一项前瞻性观察队列研究,随访时间至少为两周。

研究组共招募了651名年龄在19岁以下、实验室确诊感染SARS-CoV-2的儿童和青少年。主要结局为进入重症监护室、住院死亡或WHO规定的MIS-C。

651例参与者的中位年龄为4.6岁,12个月以下占35%,男性占56%。57%为白人,12%为南亚人,10%为黑人。42%的患儿至少有一种合并症。确定存在全身粘膜皮肤肠道症状,其中包括符合WHO MIS-C标准的症状。

18%的患儿接受重症监护,在多变量分析中,这与年龄小于1个月(优势比为3.21)、年龄为10-14岁(3.23)和黑人(2.82)有关。627例患儿中有6例(1%)死于医院,均患有严重合并症。11%的患儿符合WHO MIS-C标准,首例患儿在3月中旬出现症状。

符合MIS-C标准的患儿中位年龄为10.7岁,明显大于非MIS-C患儿(1.6岁);非白人占64%,亦显著高于非MIS-C患儿(42%);接受重症监护率为73%,远高于非MIS-C患儿(15%)。除WHO标准外,MIS-C患儿更容易出现疲劳、头痛、肌痛、咽喉痛和淋巴结病,且血小板计数更容易低于150×109 /L,差异均具有统计学意义。MIS-C患儿中无人死亡。

总之,儿童和青年人的急性covid-19严重程度低于成年人。在与MIS-C具有共同特征的急性病例中,还发现了全身粘膜皮肤肠道症状。该研究为完善WHO MIS-C病例定义提供了补充证据。

附:英文原文

Title: Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study

Author: Olivia V Swann, Karl A Holden, Lance Turtle, Louisa Pollock, Cameron J Fairfield, Thomas M Drake, Sohan Seth, Conor Egan, Hayley E Hardwick, Sophie Halpin, Michelle Girvan, Chloe Donohue, Mark Pritchard, Latifa B Patel, Shamez Ladhani, Louise Sigfrid, Ian P Sinha, Piero L Olliaro, Jonathan S Nguyen-Van-Tam, Peter W Horby, Laura Merson, Gail Carson, Jake Dunning, Peter J M Openshaw, J Kenneth Baillie, Ewen M Harrison, Annemarie B Docherty, Malcolm G Semple

Issue&Volume: 2020/08/27

Abstract: Objective To characterise the clinical features of children and young people admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK and explore factors associated with admission to critical care, mortality, and development of multisystem inflammatory syndrome in children and adolescents temporarily related to coronavirus disease 2019 (covid-19) (MIS-C).

Design Prospective observational cohort study with rapid data gathering and near real time analysis.

Setting 260 hospitals in England, Wales, and Scotland between 17 January and 3 July 2020, with a minimum follow-up time of two weeks (to 17 July 2020).

Participants 651 children and young people aged less than 19 years admitted to 138 hospitals and enrolled into the International Severe Acute Respiratory and emergency Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK study with laboratory confirmed SARS-CoV-2.

Main outcome measures Admission to critical care (high dependency or intensive care), in-hospital mortality, or meeting the WHO preliminary case definition for MIS-C.

Results Median age was 4.6 (interquartile range 0.3-13.7) years, 35% (225/651) were under 12 months old, and 56% (367/650) were male. 57% (330/576) were white, 12% (67/576) South Asian, and 10% (56/576) black. 42% (276/651) had at least one recorded comorbidity. A systemic mucocutaneous-enteric cluster of symptoms was identified, which encompassed the symptoms for the WHO MIS-C criteria. 18% (116/632) of children were admitted to critical care. On multivariable analysis, this was associated with age under 1 month (odds ratio 3.21, 95% confidence interval 1.36 to 7.66; P=0.008), age 10-14 years (3.23, 1.55 to 6.99; P=0.002), and black ethnicity (2.82, 1.41 to 5.57; P=0.003). Six (1%) of 627 patients died in hospital, all of whom had profound comorbidity. 11% (52/456) met the WHO MIS-C criteria, with the first patient developing symptoms in mid-March. Children meeting MIS-C criteria were older (median age 10.7 (8.3-14.1) v 1.6 (0.2-12.9) years; P<0.001) and more likely to be of non-white ethnicity (64% (29/45) v 42% (148/355); P=0.004). Children with MIS-C were five times more likely to be admitted to critical care (73% (38/52) v 15% (62/404); P<0.001). In addition to the WHO criteria, children with MIS-C were more likely to present with fatigue (51% (24/47) v 28% (86/302); P=0.004), headache (34% (16/47) v 10% (26/263); P<0.001), myalgia (34% (15/44) v 8% (21/270); P<0.001), sore throat (30% (14/47) v (12% (34/284); P=0.003), and lymphadenopathy (20% (9/46) v 3% (10/318); P<0.001) and to have a platelet count of less than 150 × 109/L (32% (16/50) v 11% (38/348); P<0.001) than children who did not have MIS-C. No deaths occurred in the MIS-C group.