Volume 28, Number 11—November 2022
Research
Differences in SARS-CoV-2 Clinical Manifestations and Disease Severity in Children and Adolescents by Infecting Variant
, and Asuncion Mejias1
Table 2
Demographic, laboratory characteristics and clinical outcomes of children and adolescents hospitalized with acute COVID-19 by SARS-CoV-2 variant, Columbus, Ohio, USA*
| Characteristic | Clinical inpatient cohort, n = 195† | Nonvariant, n = 26 | Alpha, n = 21 | Delta, n = 89 | Omicron, n = 59 | p value |
|---|---|---|---|---|---|---|
| Median age, y (IQR) |
5.7 (0.36–15.41) |
3.3 (1.25–15.46) |
4.1 (0.48–14.84) |
11.1 (0.69–16.05) |
0.8 (0.13–11.72) |
0.01‡ |
| Age group, y | <0.001‡ |
|||||
| <1 y | 67 (34.36) | 5 (19.23) | 8 (38.10) | 23 (25.84) | 31 (52.54) | |
| 1–4 | 27 (13.85) | 10 (38.46) | 3 (14.29) | 8 (8.99) | 6 (10.17) | |
| 5–11 | 27 (13.85) | 1 (3.85) | 2 (9.52) | 17 (19.10) | 7 (11.87) | |
| 12–21 |
74 (37.95) |
10 (38.46) |
8 (38.07) |
41 (46.07) |
15 (25.42) |
|
| Sex | ||||||
| M | 106 (54.36) | 15 (57.69) | 10 (47.62) | 50 (56.18) | 31 (52.54) | 0.89 |
| F |
89 (45.64) |
11 (42.31) |
11 (52.38) |
39 (43.82) |
28 (47.46) |
|
| Race/ethnic group | 0.02‡ |
|||||
| White | 113 (57.95) | 18 (69.23) | 8 (38.10) | 59 (66.30) | 28 (47.46) | |
| Black | 46 (23.59) | 4 (15.39) | 12 (57.14) | 16 (17.98) | 14 (23.73) | |
| Multiracial | 11 (5.64) | 2 (7.69) | 1 (4.77) | 4 (4.49) | 4 (6.78) | |
| Hispanic | 11 (5.64) | 1 (3.85) | 0 (0.00) | 5 (5.62) | 5 (8.48) | |
| Other/unknown |
14 (7.18) |
1 (3.85) |
0 (0.00) |
5 (5.62) |
8 (13.56) |
|
| Underlying conditions§ | 119 (61.03) | 17 (65.38) | 14 (66.67) | 58 (65.19) | 30 (51.72) | 0.3 |
| Obesity/overweight | 63 (32.30) | 6 (23.08) | 6 (28.57) | 38 (42.70) | 13 (22.03) | |
| Respiratory | 21 (10.77) | 3 (11.54) | 6 (28.57) | 10 (11.24) | 2 (3.39) | |
| Genetic/neurologic | 25 (12.82) | 4 (15.38) | 1 (4.76) | 11 (12.36) | 9 (15.25) | |
| Cardiac | 5 (2.56) | 3 (11.54) | 0 (0.00) | 1 (1.12) | 1 (1.69) | |
| GI/renal | 10 (5.13) | 3 (11.54) | 1 (4.76) | 6 (6.74) | 0 (0.00) | |
| Other |
4 (24.10) |
5 (19.23) |
5 (23.81) |
20 (22.47) |
17 (28.81) |
|
| SARS-CoV-2 vaccination |
5 (2.82) |
0 (0.00) |
0 (0.00) |
1 (1.13) |
4 (6.78) |
0.27 |
| Duration of illness, d (IQR) |
3 (1.00–7.00) |
3 (1.00–6.00) |
2 (1.00–5.00) |
5 (2.00–8.00) |
2 (1.00–4.00) |
<0.001‡ |
| Clinical manifestations | ||||||
| Fever | 147 (75.38) | 14 (53.85) | 16 (76.19) | 71 (79.78) | 46 (77.97) | <0.05‡ |
| Respiratory | 160 (82.05) | 16 (61.54) | 17 (80.95) | 75 (84.27) | 52 (88.14) | 0.03‡ |
| Upper respiratory | 70 (43.75) | 6 (23.08) | 8 (38.10) | 28 (31.46) | 28 (47.46) | 0.11 |
| Lower respiratory | 90 (56.25) | 10 (38.46) | 9 (42.86) | 47 (52.81) | 24 (40.68) | 0.39 |
| Cardiac | 25 (12.82) | 5 (19.23) | 3 (14.29) | 12 (13.48) | 5 (8.48) | 0.57 |
| Gastrointestinal | 83 (42.56) | 11 (42.31) | 9 (42.86) | 36 (40.45) | 27 (45.77) | 0.94 |
| Other¶ |
47 (24.10) |
9 (34.62) |
12 (57.14) |
28 (31.46) |
20 (33.90) |
0.17 |
| ALC, × 103/μL | 1.6 (0.93–3.46) | 2.2 (1.62–3.69) | 1.90 (1.26–3.36) | 1.20 (0.87–2.06) | 2.7 (0.93–4.38) | 0.01‡ |
| Lymphopenia | 105/170 (61.76) | 9 (37.50) | 13 (61.91) | 57 (72.15) | 26 (56.52) | 0.02‡ |
| CRP, mg/dL, median (IQR) | 1.4 (0.50–4.10) | 2.50 (0.65–5.75) | 0.70 (0.50-.3.40) | 1.70 (0.55–3.75) | 1.30 (0.50–4.40) | 0.62 |
| Ct, median (IQR) |
21.36 (17.28–27.69) |
27.10 (20.16–31.98) |
21.67 (16.64–26.35) |
21.24 (16.54–27.35) |
20.17 (17.80–25.26) |
0.04‡ |
| COVID-19 targeted therapy | 70 (35.90) | 6 (23.08) | 7 (33.33) | 38 (42.70) | 19 (32.20) | 0.26 |
| Oxygen supplementation |
91 (46.67) |
10 (38.46) |
9 (42.86) |
50 (56.18) |
22 (37.29) |
0.1 |
| PICU admission | 53 (27.18) | 7 (26.92) | 5 (23.81) | 26 (29.21) | 15 (25.42) | 0.94 |
| Duration of PICU stay, d (IQR) | 3.48 (1.00–7.46) | 1.00 (1.00–2.50) | 3.00 (2.00–34.00) | 4.00 (1.63–7.65) | 4.00 (2.03–5.44) | 0.26 |
| Duration of hospitalization, d (IQR) | 2.86 (1.79–7.09) | 2.10 (1.72–3.02) | 2.89 (1.81–5.00) | 3.91 (1.84–7.91) | 2.20 (1.45–7.33) | 0.17 |
*Values are no. (%) except as indicated. Continuous variables were analyzed by analyzed by Kruskal-Wallis test. Categorical data were analyzed by χ2 test. Bold text indicates statistical significance. ALC, absolute lymphocyte count; CRP, C-reactive protein; GI, gastrointestinal; IQR, interquartile range; PICU, pediatric intensive care unit. †Patients with multisystem inflammatory syndrome in children, SARS-CoV-2 detected by screening but hospitalized for other reasons, and those infected with uncommon SARS-CoV-2 strains were excluded from analyses. ‡p values represent statistical significance between groups based on Kruskal-Wallis or χ2 test. Ad hoc adjusted p values from pairwise comparisons were as follows: age, p<0.01 between Omicron and Delta; duration of illness, Delta vs. nonvariant infections (p = 0.03), Delta vs. Alpha (p not significant); and Delta vs. Omicron (p<0.001); fever, nonvariant vs. Delta (p = 0.01), nonvariant vs. Omicron (p = 0.04); respiratory symptoms, nonvariant vs. Delta (p = 0.03), nonvariant vs Omicron (p < 0.01). Total ALC, Delta vs. nonvariant infections (p = 0.03); lymphopenia, Delta vs. nonvariant infections (p<0.01). Ct values: nonvariant vs. Delta (p = 0.03), nonvariant vs Omicron (p = 0.03). §Underlying conditions: respiratory (asthma, bronchopulmonary dysplasia, cystic fibrosis); cardiac (septal defects, valvopathies; dilated cardiomyopathy); endocrinologic (diabetes, dyslipidemia, panhypopituitarism and polyendocrinopathy); hematologic (sickle cell disease, spherocytosis, thalassemia, chronic idiopathy thrombocytopenia purpura); immunocompromised conditions (solid or hematopoietic organ transplantation, malignancies–leukemias, solid tumors, rheumatologic conditions receiving chronic immunosuppressive therapy, primary immunodeficiencies, HIV); neurologic and genetic conditions (cerebral palsy, autism, developmental delay); prematurity; renal/gastrointestinal conditions (Hirschsprung’s, duodenal atresia, short bowel syndrome, chronic kidney disease, intestinal bowel disease, nephrotic syndrome); and obesity/overweight. ¶Other symptoms: anosmia, fatigue, myalgias, headache, back pain, chills, polyarthralgia, hemoptysis, rash. Lymphopenia defined as ALC of <4,500 cells/μL in infants, and <1,500 cells/μL in children >12 mo of age (18).
1These authors contributed equally to and co-directed this work.