In a nationwide case collection, 11.4% of immunocompromised sufferers youthful than 21 years with COVID-19 admitted for intensive care died, in comparison with 4.6% of their friends with wholesome immune techniques.
The examine, printed in Scientific Infectious Ailments, included pediatric sufferers seen in 55 hospitals in 30 US states. All sufferers have been below the age of 21 and admitted to a pediatric intensive care unit (PICU) or high-acuity unit for acute COVID-19 from March 12, 2020, by means of December 30, 2021.
Of 1,274 sufferers, 105 (8.2%) had a pre-existing immunocompromising situation (ICC), together with 33 (31.4%) with hematologic malignancies, 24 (22.9%) with major immunodeficiencies and issues of hematopoietic cells, 19 (18.1%) with nonmalignant organ failure after strong organ transplant, 16 (15.2%) with strong tumors, and 13 (12.4%) with autoimmune issues.
Sufferers with and with out ICC had comparable scientific illness severity upon admission, the authors stated. Sufferers within the PICU for COVID-19 who had ICCs have been, nevertheless, older than these with out ICCs and fewer prone to be overweight.
Scientific presentation comparable in each teams
Each teams of youngsters had comparable charges of mechanical air flow, vasoactive infusions, and extracorporeal membrane oxygenation use. “Regardless of similarities in scientific presentation, the outcomes have been worse for these with ICCs,” the authors wrote.
Along with virtually triple the speed of in-hospital mortality, sufferers with ICCs had longer hospital stays.
Among the many 105 sufferers with ICCs, 16.2% had life-threatening COVID-19, however reassuringly, COVID-19 ICC sufferers confirmed no proof of latest neurologic incapacity or want for supplemental oxygen, tracheostomy, or mechanical air flow.
Sufferers with life-threatening COVID-19 have been older than these with non–life-threatening COVID-19, however there have been no statistically important variations in biologic intercourse, race, ethnicity.
“Sufferers with life-threatening COVID-19 have been older than these with non–life-threatening COVID-19, however there have been no statistically important variations in biologic intercourse, race, ethnicity, or comorbidities related to life-threatening COVID-19 in sufferers with ICCs,” the authors wrote.
Stem cell transplant sufferers at best threat of demise
No single sort of ICC was extra prone to be related to extreme COVID-19 an infection, however sufferers with allogeneic hematopoietic stem cell transplant (HSCT) have been overrepresented in hospital deaths.
5 of the 14 deaths in ICC sufferers occurred in youngsters with HSCT, representing 35.7% of in-hospital deaths for that group.
“Sufferers with a historical past of HSCT represented just one% of the general cohort with acute COVID-19 however comprised virtually half of the fatalities,” the researchers wrote. “These findings are in step with the excessive mortality of youngsters with post-HSCT admitted to the PICU for different indications. Though our numbers are small, these sufferers who developed COVID-19 earlier than or after post-transplantation day 100 had comparable charges of life-threatening COVID-19, just like what has been reported beforehand.”