What is the association between individual congenital and acquired cardiovascular conditions and COVID-19 severity in pediatric patients?
In this cohort study of 171 416 US individuals aged 2 months to 17 years with SARS-CoV-2 infection, cardiac arrest, cardiogenic shock, heart surgery, cardiopulmonary disease, heart failure, hypotension, nontraumatic cerebral hemorrhage, pericarditis, and biventricular defects were associated with increased COVID-19 severity.
The findings suggest that previous or preexisting cardiovascular conditions are associated with increased COVID-19 severity, in varying degrees, in pediatric patients.
Identifying the associations between severe COVID-19 and individual cardiovascular conditions in pediatric patients may inform treatment.
To assess the association between previous or preexisting cardiovascular conditions and severity of COVID-19 in pediatric patients.
Design, Setting, and Participants
This retrospective cohort study used data from a large, multicenter, electronic health records database in the US. The cohort included patients aged 2 months to 17 years with a laboratory-confirmed diagnosis of COVID-19 or a diagnosis code indicating infection or exposure to SARS-CoV-2 at 85 health systems between March 1, 2020, and January 31, 2021.
Diagnoses for 26 cardiovascular conditions between January 1, 2015, and December 31, 2019 (before infection with SARS-CoV-2).
Main Outcomes and Measures
The main outcome was severe COVID-19, defined as need for supplemental oxygen or in-hospital death. Mixed-effects, random intercept logistic regression modeling assessed the significance and magnitude of associations between 26 cardiovascular conditions and COVID-19 severity. Multiple comparison adjustment was performed using the Benjamini-Hochberg false discovery rate procedure.
The study comprised 171 416 pediatric patients; the median age was 8 years (IQR, 2-14 years), and 50.28% were male. Of these patients, 17 065 (9.96%) had severe COVID-19. The random intercept model showed that the following cardiovascular conditions were associated with severe COVID-19: cardiac arrest (odds ratio [OR], 9.92; 95% CI, 6.93-14.20), cardiogenic shock (OR, 3.07; 95% CI, 1.90-4.96), heart surgery (OR, 3.04; 95% CI, 2.26-4.08), cardiopulmonary disease (OR, 1.91; 95% CI, 1.56-2.34), heart failure (OR, 1.82; 95% CI, 1.46-2.26), hypotension (OR, 1.57; 95% CI, 1.38-1.79), nontraumatic cerebral hemorrhage (OR, 1.54; 95% CI, 1.24-1.91), pericarditis (OR, 1.50; 95% CI, 1.17-1.94), simple biventricular defects (OR, 1.45; 95% CI, 1.29-1.62), venous embolism and thrombosis (OR, 1.39; 95% CI, 1.11-1.73), other hypertensive disorders (OR, 1.34; 95% CI, 1.09-1.63), complex biventricular defects (OR, 1.33; 95% CI, 1.14-1.54), and essential primary hypertension (OR, 1.22; 95% CI, 1.08-1.38). Furthermore, 194 of 258 patients (75.19%) with a history of cardiac arrest were younger than 12 years.
Conclusions and Relevance
The findings suggest that some previous or preexisting cardiovascular conditions are associated with increased severity of COVID-19 among pediatric patients in the US and that morbidity may be increased among individuals children younger than 12 years with previous cardiac arrest.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: March 25, 2022.
Published: May 17, 2022. doi:10.1001/jamanetworkopen.2022.11967
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Ehwerhemuepha L et al. JAMA Network Open.
Corresponding Author: Louis Ehwerhemuepha, PhD, 1201 W La Veta Ave, Orange, CA 92868 (firstname.lastname@example.org).
Author Contributions: Dr Ehwerhemuepha had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Ehwerhemuepha, Patel, Arrieta, Sanger, Cooper, Shahbaba, Chang, Feaster, Taraman, Marano.
Acquisition, analysis, or interpretation of data: Ehwerhemuepha, Roth, Patel, Heutlinger, Heffernan, Feaster, Taraman, Morizono, Marano.
Drafting of the manuscript: Ehwerhemuepha, Roth, Heutlinger, Heffernan, Sanger, Cooper, Taraman, Marano.
Critical revision of the manuscript for important intellectual content: Ehwerhemuepha, Roth, Patel, Heutlinger, Heffernan, Arrieta, Shahbaba, Chang, Feaster, Taraman, Morizono, Marano.
Statistical analysis: Ehwerhemuepha, Shahbaba, Chang.
Obtained funding: Ehwerhemuepha.
Administrative, technical, or material support: Ehwerhemuepha, Sanger, Chang, Feaster, Taraman, Morizono.
Supervision: Ehwerhemuepha, Patel, Sanger, Chang, Feaster, Taraman, Morizono, Marano.
Conflict of Interest Disclosures: Dr Taraman reported receiving personal fees from Pediatric Subspecialty Faculty/Children’s Health of Orange County (CHOC) Specialists during the conduct of the study, Cognoa, Cognito Therapeutics, Chapman University, and MI10; fees as an advisor with vested stock from HandzIn and as a volunteer board member from American Academy of Pediatrics, California and Orange County Chapter; and grants from Innovative Health Solutions outside the submitted work. Dr Morizono reported receiving grants from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) during the conduct of the study. No other disclosures were reported.
Funding/Support: The study was funded by a Small Grants award from CHOC Chief Scientific Officer. Drs Patel and Morizono were supported by grants UL1TR001876 and KL2TR001877 from the NIH Clinical and Translational Science Award Program.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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