Risk Factors For Severe Disease Research Articles

Comparison of the clinical characteristics and outcomes of Japanese patients with COVID-19 treated in primary, secondary, and tertiary care facilities

AimTo compare the characteristics and clinical course of patients with coronavirus disease (COVID-19) according to the healthcare level of the admitted hospital, to provide an insight into determining the appropriate level of care for each patient. MethodsThis retrospective, observational study utilized data from the COVID-19 Registry Japan (COVIREGI-JP), the largest Japanese registry of hospitalized patients with COVID-19. Datasets were obtained from reports filed as of May 31, 2022. ResultsA total of 59,707 patients (2004 in the primary care group, 41,420 in the secondary care group, and 16,283 in the tertiary care group) from 585 facilities were included in the analysis. Patients with established risk factors for severe disease, such as old age and the presence of comorbidities, were treated at higher care facilities and had poorer initial conditions and in-hospital clinical course, as well as higher mortality. Analysis of the fatality rates for each complication suggested that patients with complications requiring procedures (e.g. pleural effusions, myocardial ischemia, and arrhythmia) may have better survival rates in facilities with specialist availability. The number of deaths and severe COVID-19 cases in this study were notably less than those reported overseas. ConclusionOur results showed that more difficult COVID-19 cases with poor outcomes were treated at higher care level facilities in Japan. Attending to possible complications may be useful for selecting an appropriate treatment hospital. Healthcare providers need to maintain a broad perspective on the distribution of medical resources.

Population Risk Factors for Severe Disease and Mortality in COVID-19 in the United States during the Pre-Vaccine Era: A Retrospective Cohort Study of National Inpatient Sample

Background-Previous studies on coronavirus disease 2019 (COVID-19) were limited to specific geographical locations and small sample sizes. Therefore, we used the National Inpatient Sample (NIS) 2020 database to determine the risk factors for severe outcomes and mortality in COVID-19. Methods-We included adult patients with COVID-19. Univariate and multivariate logistic regression was performed to determine the predictors of severe outcomes and mortality in COVID-19. Results-1,608,980 (95% CI 1,570,803-1,647,156) hospitalizations with COVID-19 were included. Severe complications occurred in 78.3% of COVID-19 acute respiratory distress syndrome (ARDS) and 25% of COVID-19 pneumonia patients. The mortality rate for COVID-19 ARDS was 54% and for COVID-19 pneumonia was 16.6%. On multivariate analysis, age > 65 years, male sex, government insurance or no insurance, residence in low-income areas, non-white races, stroke, chronic kidney disease, heart failure, malnutrition, primary immunodeficiency, long-term steroid/immunomodulatory use, complicated diabetes mellitus, and liver disease were associated with COVID-19 related complications and mortality. Cardiac arrest, septic shock, and intubation had the highest odds of mortality. Conclusions-Socioeconomic disparities and medical comorbidities were significant determinants of mortality in the US in the pre-vaccine era. Therefore, aggressive vaccination of high-risk patients and healthcare policies to address socioeconomic disparities are necessary to reduce death rates in future pandemics.

EPH64 Public Health Impact of COVID-19 in French Ambulatory Patients With at Least One Risk Factor for Severe Disease

In the fight against the pandemic, it was essential to join forces with professionals to better understand the resources involved in the care ecosystem. A public health impact model was developed to estimate the health and economic burden of COVID-19, to support future choices of resource allocations and to allow comparison with other diseases. A Markov model was used to estimate life years, costs, number of hospitalisations, number of deaths and long/prolonged COVID forms over a time horizon of 2 years. Data from the literature suggest that the age of patients can affect the risk of hospitalisation and the risk of death during hospitalisation, hence the model was stratified by age group. The hospitalisation probabilities were derived from a Temporary Use Authorisation cohort, and the hospitalisation stays characteristics were derived from the French national hospital discharge database. Several scenarios were conducted. Over the model time horizon and in a situation where patients were not treated, the number of hospitalisations reached 256 per 1,000 patients in the acute phase and 382 per 1,000 patients overall. The number of deaths in the acute phase was 37 per 1,000 patients, and the number of long/prolonged COVID forms reached 407 per 1,000 patients. These translated into a reduction of 0.7 days of life per patient in the acute phase (versus the maximum lifetime during the acute phase: 30.4 days), with an average cost of €1,578, and a reduction of 27 days of life over the time horizon (versus the maximum lifetime during the whole simulation considering natural mortality: 2 years and 15.8 days), with an average cost of €4,280. This study shows that the health and economic burden is considerable especially for the elderly and/or unvaccinated and goes beyond the acute phase because of the effects and consequences of the long/prolonged COVID forms.

The rs17713054 and rs1800629 polymorphisms of genes LZTFL1 and TNF are associated with COVID-19 severity

Both genetic and non-genetic factors are responsible for high interindividual variability in response to SARS-CoV-2. Despite the fact that multiple genetic polymorphisms have been identified as risk factors of severe COVID-19, such polymorphisms are still insufficiently studied in the Russian population. The study was aimed to identify genetic determinants associated with severe COVID-19 in the sample of patients from the Russian Federation. The correlation of the rs17713054 polymorphism in gene LZTFL1 and rs1800629 polymorphism in gene TNF (tumor necrosis factor) with the COVID-19 severity was assessed. DNA samples obtained from 713 patients (324 males and 389 females) aged 18‒95 with COVID-19 of varying severity were analyzed. The rs1800629 polymorphism of gene TNF (OR = 1.5; p = 0.02) and rs17713054 polymorphism of gene LZTFL1 (OR = 1.60; p = 0.0043) were identified as risk factors of severe disease. The TNF polymorphism rs1800629 and LZTFL1 polymorphism rs17713054 could be considered as potential predictive biomarkers. The rs17713054 G > A polymorphism was strongly associated with severe disease. In the future the findings may provide the basis for the development of test-systems for prediction of the risk of severe viral respiratory diseases.

Risk factors for severe disease and impact of severity on pregnant women with COVID-19: a case–control study based on data from a nationwide survey of maternity services in Japan

ObjectiveTo identify independent risk factors for severe COVID-19 in pregnant women and to evaluate the impact of disease severity on preterm birth.DesignA case–control study based on data from a nationwide...

Retrospective Study to Identify Risk Factors for Severe Disease and Mortality Using the Modified Early Warning Score in 5127 Patients with COVID-19 Admitted to an Emergency Department in Poland Between March 2020 and April 2021.

BACKGROUND COVID-19, a disease caused by SARS-CoV-2, has posed a threat to global public health. This retrospective study of 5127 patients with COVID-19 admitted to an Emergency Department in Poland between March 2020 and April 2021 aimed to identify risk factors for severe disease and mortality using the modified early warning score (MEWS). MATERIAL AND METHODS The study was based on a retrospective analysis of patients with SARS-CoV-2 infection admitted to the Emergency Department between March 2020 and April 2021. A total of 5127 cases were included in the final analysis. Identifying the group of high-risk patients with COVID-19 was determined based on the MEWS score. RESULTS Most of the patients studied were male (53.38%). The in-hospital mortality rate among the patients was 21.53%. The factors associated with the risk of in-hospital mortality from COVID-19 were age (>60 years, hazard ratio [HR]=2.27, P<0.001), comorbidities (cancer, HR=1.39, P=0.005; heart failure, HR=1.31, P=0.009; renal failure, HR=1.37, P=0.004), higher MEWS score (MEWS ≥5, HR=1.43, P<0.001), higher percentage of lung parenchyma affected (>50%, HR=2.10, P=0.001), and higher respiratory rate (>24 breaths per min, HR=2.10, P<0.001). CONCLUSIONS This study produced real-world data of risk factors for mortality from COVID-19 and the use of the MEWS for a faster identification of patients with COVID-19 requiring more intensive medical care.

Respiratory viral infections and their role in human cardiovascular diseases

Acute respiratory viral infections are the most common human diseases. Symptoms of the infection vary from a slight cold to critical condition requiring artificial lung ventilation and support of cardiovascular system. Main risk factors of severe disease include high viral load, co-infection with other pathogens, age from 0 to 2 years and older than 65 years, and immunodeficiency. Cardiac manifestations of the infection are usually caused by indirect effects due to inflammatory reaction resulting in systemic increase in proinflammatory cytokines, so called cytokine storm. However, there have been reports on the identification of respiratory viruses isolated directly from the myocardial tissue, or testing of viral RNA in the myocardium using real-time polymerase chain reaction. This review discusses the direct and indirect effects of respiratory viral infections on causing cardiovascular complications. The authors discuss the similarities and differences of the immunopathogenic mechanisms associated with COVID-19, influenza infection, as well as diseases caused by enteroviruses, respiratory syncytial viruses, metapneumoviruses, and parainfluenza viruses.

Respiratory viral infections and their role in human cardiovascular diseases

Acute respiratory viral infections are the most common human diseases. Symptoms of the infection vary from a slight cold to critical condition requiring artificial lung ventilation and support of cardiovascular system. Main risk factors of severe disease include high viral load, co-infection with other pathogens, age from 0 to 2 years and older than 65 years, and immunodeficiency. Cardiac manifestations of the infection are usually caused by indirect effects due to inflammatory reaction resulting in systemic increase in proinflammatory cytokines, so called cytokine storm. However, there have been reports on the identification of respiratory viruses isolated directly from the myocardial tissue, or testing of viral RNA in the myocardium using real-time polymerase chain reaction. This review discusses the direct and indirect effects of respiratory viral infections on causing cardiovascular complications. The authors discuss the similarities and differences of the immunopathogenic mechanisms associated with COVID-19, influenza infection, as well as diseases caused by enteroviruses, respiratory syncytial viruses, metapneumoviruses, and parainfluenza viruses.

Plasma exchange and COVID 19

Plasma exchange and COVID 19

Evaluation of Glycemic Control and Predictors of Severe Illness and Death in Patients with Diabetes Hospitalized With COVID-19.

To identify risk factors for severe disease and death among patients with diabetes and coronavirus disease 2019 (COVID-19) infection. This retrospective cohort study conducted at three hospitals included 733 consecutive patients with DM admitted with confirmed COVID-19 (March 1 - December 31, 2020). Multivariable logistic regression was performed to identify predictors of severe disease and death. The mean age was 67.4 ± 14.3 years, 46.9% were males and 61.5% were African American. Among all patients, 116 (15.8%) died in the hospital. A total of 317 (43.2%) patients developed severe disease, 183 (25%) were admitted to an ICU and 118 (16.1%) required invasive mechanical ventilation. Increasing BMI (OR, 1.13; 95% CI, 1.02-1.25), history of chronic lung disease (OR, 1.49; 95% CI, 1.05-2.10) and increasing time since the last HbA1c test (OR, 1.25; 95% CI, 1.05-1.49) were the preadmission factors associated with increased odds of severe disease. Preadmission use of metformin (OR, 0.67; 95% CI, 0.47-0.95) or GLP-1 agonists (OR, 0.49; 95% CI, 0.27-0.87) was associated with decreased odds of severe disease. Increasing age (OR, 1.21; 95% CI, 1.09-1.34), co-existing chronic kidney disease greater than stage 3 (OR, 3.38; 95% CI, 1.67-6.84), ICU admission (OR, 2.93; 95% CI, 1.28-6.69) and use of invasive mechanical ventilation (OR, 8.67, 95% CI, 3.88-19.39) were independently associated with greater odds of in-hospital death. Several clinical characteristics were identified to be predictive of severe disease and in-hospital death among patients with underlying diabetes hospitalized with COVID-19.

Asthma as a comorbidity in COVID-19 pediatric ICU admissions in a large metropolitan children's hospital.

Children contribute to 5% ofcoronavirus disease of 2019 (COVID-19)-related hospitalizations in the United States. There is mounting evidence suggesting childhood asthma is a risk factor for severe disease. We hypothesized that asthma is associated with longer length of stay (LOS) and need for respiratory support among children admitted to pediatric intensive care unit (PICU) with COVID-19. We reviewed 150 charts of children and young adults with a positivesevere acute respiratory syndrome coronavirus 2polymerase chain reaction test admitted to the PICU at Children's National Hospital, Washington, DC between 2020 and 2021. We recorded demographics, anthropometrics, past medical history, clinical course, laboratory findings, imaging, medication usage, respiratory support, and outcomes. Functional Status Scale (FSS), which measures an Intensive Care Unitpatient's physical function, was used to characterize children with multiple comorbidities; FSS and obesity were included as covariates in multivariate analysis. Statistical analysis was performed using SPSS v25.0. Sixty-Eight patients ages 0-21 years met inclusion criteria. Median age was 14.9 years, 55.9% were female, median Body Mass Index percentile was 62, and 42.6% were African American. Compared with those without asthma, patients with asthma averaged longer LOS (20.7 vs. 10.2 days, p = 0.02), with longer PICU stay (15.9 vs. 7.6 days, p = 0.033) and prolonged maximum respiratory support (8.3 vs. 3.3 days, p = 0.016). Adjusted for obesity and poor physical function (FSS > 6), asthma remained a significant predictor of hospital LOS, PICU LOS, and days on maximum respiratory support. Asthma can cause severe disease with prolonged need for maximum respiratory support among children with COVID-19.

Surfactant protein D (SP-D) as a biomarker of SARS-CoV-2 infection

BackgroundSurfactant protein-D (SP-D) is a lung-resident protein that has emerged as a potential biomarker for COVID-19. Previous investigations on acute respiratory distress syndrome patients demonstrated a significant increment of SP-D serum levels in pathological conditions. Since SP-D is not physiologically permeable to alveoli-capillary membrane and poorly expressed by other tissues, this enhancement is likely due to an impairment of the pulmonary barrier caused by prolonged inflammation. MethodsA retrospective study on a relatively large cohort of patients of Hospital Pio XI of Desio was conducted to assess differences of the hematic SP-D concentrations among COVID-19 patients and healthy donors and if SP-D levels resulted a risk factor for disease severity and mortality. ResultsThe first analysis, using an ANOVA-model, showed a significant difference in the mean of log SP-D levels between COVID-19 patients and healthy donors. Significant variations were also found between dead vs survived patients. Results confirm that SP-D concentrations were significantly higher for both hospitalized COVID-19 and dead patients, with threshold values of 150 and 250 ng/mL, respectively. Further analysis conducted with Logistic Mixed models, highlighted that higher SP-D levels at admission and increasing differences among follow-up and admission values resulted the strongest significant risk factors of mortality (model predictive accuracy, AUC = 0.844). ConclusionsThe results indicate that SP-D can be a predictive marker of COVID-19 disease and its outcome. Considering its prognostic value in terms of mortality, the early detection of SP-D levels and its follow-up in hospitalized patients should be considered to direct the therapeutic intervention.

Pesticides as endocrine disruptors: programming for obesity and diabetes.

Exposure to pesticides has been associated with obesity and diabetes in humans and experimental models mainly due to endocrine disruptor effects. First contact with environmental pesticides occurs during critical phases of life, such as gestation and lactation, which can lead to damage in central and peripheral tissues and subsequently programming disorders early and later in life. We reviewed epidemiological and experimental studies that associated pesticide exposure during gestation and lactation with programming obesity and diabetes in progeny. Maternal exposure to organochlorine, organophosphate and neonicotinoids, which represent important pesticide groups, is related to reproductive and behavioral dysfunctions in offspring; however, few studies have focused on glucose metabolism and obesity as outcomes. We provide an update regarding the use and metabolic impact of early pesticide exposure. Considering their bioaccumulation in soil, water, and food and through the food chain, pesticides should be considered a great risk factor for several diseases. Thus, it is urgent to reformulate regulatory actions to reduce the impact of pesticides on the health of future generations.

50 Risk factors for severe COVID-19 in hospitalized children in Canada: A national prospective study from March 2020–May 2021

Abstract Background Children living with chronic comorbid conditions are at increased risk for severe COVID-19 disease, though there is limited evidence regarding the risks associated with specific conditions and which children may benefit from targeted COVID-19 therapies. Age-specific baseline indicators of COVID-19 severity are also needed to evaluate the effectiveness of SARS-CoV-2 vaccination strategies in the paediatric population. Objectives In this study, we aimed to 1) identify factors associated with severe COVID-19 in children, and 2) describe rates of hospitalization, intensive care unit (ICU) admission, and severe COVID-19 within specific pediatric age groups. Design/Methods We conducted a national prospective study on hospitalized children with microbiologically confirmed SARS-CoV-2 infection via the Canadian Paediatric Surveillance Program from March 2020–May 2021. Cases were reported voluntarily by a network of &amp;gt;2800 paediatricians and paediatric subspecialists. SARS-CoV-2 hospitalizations were classified as COVID-19-related, incidental infection, or infection control/social admissions. Severe disease was defined as intensive care, ventilatory or hemodynamic requirements, select organ system complications, or death. Outcomes were described among children aged &amp;lt;6 months, 6–23 months, 2–4 years, 5–11 years, and 12–17 years. Risk factors for severe disease were identified using multivariable Poisson regression, adjusting for child age and sex, coinfections, and timing of hospitalization. Results We identified 541 children hospitalized with SARS-CoV-2 infection, including 329 (60.8%) with COVID-19-related disease. Median age at admission was 2.8 years (IQR 0.3-13.5) and 42.9% (n=232) had at least one comorbidity. Among COVID-19-related hospitalizations, severe disease occurred in 29.5% of children (n=97/329), including a higher proportion of children aged 2–4 years (48.7%) and 12–17 years (41.3%) (Table 1). Comorbidities associated with severe disease are described in Figure 1, and included technology dependence (adjusted risk ratio [aRR] 1.96, 95% confidence interval [CI] 1.31-2.95), neurologic conditions (e.g. epilepsy and chromosomal/genetic conditions) (aRR 1.87, 95% CI 1.34-2.61), and pulmonary conditions (e.g. bronchopulmonary dysplasia and uncontrolled asthma) (aRR 1.66, 95% CI 1.13-2.42). Conclusion While severe outcomes were detected at all ages and among patients with and without comorbidities, neurologic and pulmonary conditions as well as technology dependence were associated with increased risk of severe COVID-19. Children aged 2–4 years more commonly experienced severe COVID-19 in this study, which was conducted at a time when no children were eligible for SARS-CoV-2 vaccines. Notably, this high-risk group remains without access to approved vaccines. These findings may help guide vaccination programs and prioritize targeted COVID-19 therapies for children.

Rapid investigation of BA.4/BA.5 cases in France.

AimWe aimed to describe the characteristics of individuals infected by BA.4 or BA.5 in France in comparison to BA.1, and analyze the factors associated with hospitalization among BA.4 and BA.5 cases.MethodsA standardized questionnaire was used to collect information on confirmed and probable Omicron cases. Hospitalization risk factors among BA.4/BA.5 cases were analyzed using Poisson regression. Variables with a p-value below 0.2 in the univariate analysis and a priori confounders were included in the multivariable regression model.ResultsThe median age of the 301 cases investigated was 47 years and 97% of cases were symptomatic. The most common clinical signs were asthenia/fatigue (75.7%), cough (58.3%), fever (58.3%), headache (52.1%) and rhinorrhea (50.7%). Twelve cases were hospitalized, and 27.1% reported risk factors. No admissions to intensive care and no deaths were reported. Vaccination status was available for 292 cases, 20.9% were unvaccinated, 1.4% had received one dose, 38.3% two doses and 39.4% three doses. Cases presenting at least one risk factor were almost seventeen times more likely to be hospitalized than those with no risk factors (aRR = 16.72 [95% CI2.59–326.86]).ConclusionDespite the longer duration of and the differences in symptoms and their possible immune escape, BA.4/BA.5 Omicron sub-lineages globally showed no severe clinical presentation. The presence of at least one risk factor for severe disease significantly increased the risk of hospitalization for those infected with BA.4 or BA.5.

Respiratory Virus Surveillance Among Children with Acute Respiratory Illnesses - New Vaccine Surveillance Network, United States, 2016-2021.

The New Vaccine Surveillance Network (NVSN) is a prospective, active, population-based surveillance platform that enrolls children with acute respiratory illnesses (ARIs) at seven pediatric medical centers. ARIs are caused by respiratory viruses including influenza virus, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), human parainfluenza viruses (HPIVs), and most recently SARS-CoV-2 (the virus that causes COVID-19), which result in morbidity among infants and young children (1-6). NVSN estimates the incidence of pathogen-specific pediatric ARIs and collects clinical data (e.g., underlying medical conditions and vaccination status) to assess risk factors for severe disease and calculate influenza and COVID-19 vaccine effectiveness. Current NVSN inpatient (i.e., hospital) surveillance began in 2015, expanded to emergency departments (EDs) in 2016, and to outpatient clinics in 2018. This report describes demographic characteristics of enrolled children who received care in these settings, and yearly circulation of influenza, RSV, HMPV, HPIV1-3, adenovirus, human rhinovirus and enterovirus (RV/EV),* and SARS-CoV-2 during December 2016-August 2021. Among 90,085 eligible infants, children, and adolescents (children) aged <18 years† with ARI, 51,441 (57%) were enrolled, nearly 75% of whom were aged <5 years; 43% were hospitalized. Infants aged <1 year accounted for the largest proportion (38%) of those hospitalized. The most common pathogens detected were RV/EV and RSV. Before the emergence of SARS-CoV-2, detected respiratory viruses followed previously described seasonal trends, with annual peaks of influenza and RSV in late fall and winter (7,8). After the emergence of SARS-CoV-2 and implementation of associated pandemic nonpharmaceutical interventions and community mitigation measures, many respiratory viruses circulated at lower-than-expected levels during April 2020-May 2021. Beginning in summer 2021, NVSN detected higher than anticipated enrollment of hospitalized children as well as atypical interseasonal circulation of RSV. Further analyses of NVSN data and continued surveillance are vital in highlighting risk factors for severe disease and health disparities, measuring the effectiveness of vaccines and monoclonal antibody-based prophylactics, and guiding policies to protect young children from pathogens such as SARS-CoV-2, influenza, and RSV.

At-home Testing and Risk Factors for Acquisition of SARS-CoV-2 Infection in a Major US Metropolitan Area.

Unbiased assessment of the risks associated with acquisition of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical to informing mitigation efforts during pandemics. The objective of our study was to understand the risk factors for acquiring coronavirus disease 2019 (COVID-19) in a large prospective cohort of adult residents in a large US metropolitan area. We designed a fully remote longitudinal cohort study involving monthly at-home SARS-CoV-2 polymerase chain reaction (PCR) and serology self-testing and monthly surveys. Between October 2020 and January 2021, we enrolled 10 289 adults reflective of the Boston metropolitan area census data. At study entry, 567 (5.5%) participants had evidence of current or prior SARS-CoV-2 infection. This increased to 13.4% by June 15, 2021. Compared with Whites, Black non-Hispanic participants had a 2.2-fold greater risk of acquiring COVID-19 (hazard ratio [HR], 2.19; 95% CI, 1.91-2.50; P < .001), and Hispanics had a 1.5-fold greater risk (HR, 1.52; 95% CI, 1.32-1.71; P < .016). Individuals aged 18-29, those who worked outside the home, and those living with other adults and children were at an increased risk. Individuals in the second and third lowest disadvantaged neighborhood communities were associated with an increased risk of acquiring COVID-19. Individuals with medical risk factors for severe disease were at a decreased risk of SARS-CoV-2 acquisition. These results demonstrate that race/ethnicity and socioeconomic status are the biggest determinants of acquisition of infection. This disparity is significantly underestimated if based on PCR data alone, as noted by the discrepancy in serology vs PCR detection for non-White participants, and points to persistent disparity in access to testing. Medical conditions and advanced age, which increase the risk for severity of SARS-CoV-2 disease, were associated with a lower risk of COVID-19 acquisition, suggesting the importance of behavior modifications. These findings highlight the need for mitigation programs that overcome challenges of structural racism in current and future pandemics.

Перебіг COVID-19 у госпіталізованих дітей

Purpose - to study the features of COVID-19 in hospitalized children. Materials and methods. Retrospective multicenter clinical and epidemiological study which includes 328 hospitalized children with laboratory-confirmed COVID-19 for the period from January to August 2021. Results. the highest specific weight among all hospitalized children falls on children of the first year (75/328; 22.8%), in general, early childhood (up to 3 years) accounted for 43% (141/328) of all hospitalizations of children with COVID-19. Common symptoms of the disease included fever, upper respiratory symptoms, intoxication, diarrhea. In 99/328 (30.1%) hospitalized children pneumonia has developed, 50/99 (50.5%) of which needed oxygen support, 10/99 (10.1%) - mechanical ventilation. Pneumonia was most common in children under 1 year, children of the first 5 years of life accounted for more than a half of all pneumonia cases (53/99; 53,5%). 13/328 (3.9%) children were hospitalized to the intensive care unit. Comorbidities including endocrine, oncological, neurological diseases, congenital malformations and others, were noted in 24.6% of hospitalized children. In children with comorbid conditions, pneumonia occurred 2 times more often (relative risk factor RR=1.98, CI 95%), the relative risk of getting into resuscitation RR in the presence of comorbidity is 10.86 (CI 95%). In addition to children with pneumonia, oxygen support or mechanical ventilation required children with obstructive syndrome, pancytopenia, convulsions. The largest proportion of comorbidities in patients hospitalized to the intensive care unit were diseases of the nervous system (congenital malformations of the CNS, cerebral palsy, epilepsy, astrocytoma). Lymphopenia and thrombocytopenia were most commonly associated with severe COVID-19. Conclusions. Children of all ages are susceptible to COVID-19. The main risk factors for severe disease are early age and the presence of comorbid conditions, among which the most relevant are diabetes, obesity, neurological diseases and cancer. The presence of comorbidities in children determines the priority groups for the prevention of coronavirus infection through vaccination. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the Shupyk National Healthcare University of Ukraine. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Is low level of serum phosphorus within normal range a predictive parameter for disease severity in hospitalized COVID-19 patients?

Background: Patients with COVID-19 may develop several electrolyte imbalances that can cause multiple clinical complications. Low serum phosphorous level usually leads to a decreased muscle ATP synthesis which may cause diaphragmatic or other kinds of respiratory muscle weakness. We investigated the predictive power of serum phosphorus levels in patients with hospitalized COVID-19. &#x0D; Material and Methods: This is a retrospective and observational study of 957 patients with SARS-CoV-2, who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to moderate and severe COVID-19 pneumonia. &#x0D; Results: Among 957 patients with COVID-19 pneumonia, 387 (40,4%) were moderate and 570 (59,6%) were severe. Phosphorus was significantly lower in severe patients, within the reference range. Our final analysis showed that age, respiratory rate, d-dimer, and phosphorus level were independent risk factors for disease severity. Phosphorus was found to be negative correlated with respiratory rate (r: 0,091, p=0,005) and was positive correlated with SPO2 (r: 0,069, p=0,03).&#x0D; Conclusion: Our results suggest prognostic significance of phosphorus level, which has correlation with the respiratory rate and has considered to be independent risk factor for disease status, especially in severe patients. It is concluded that phosphorus monitoring, at least in severe patients, may prevent serious clinical consequences such as respiratory insufficiency.&#x0D; &#x0D; Keyword; COVID-19, pneumonia, phosphorus, respiratory muscle, disease status, predictive value

The impact of birth weight and gestational age on acute mastoiditis in children.

Previous data correlate preterm and low birth weight (LBW) with acute otitis media, but there is a gap concerning the relations with acute mastoiditis (AM). This study investigates the effect of LBW and preterm birth on AM disease severity, neuro-otological complications, and recurrence. Retrospective cohort. Tertiary medical center. The cohort is retrospective in nature consisting of 294 children with AM admitted between 1999 and 2020. Data collection included: patient gestational age and birth weight, signs and symptoms, physical examination, laboratory tests, imaging findings, and long-term outcomes. 294 cases of AM were included, 41/281 (15%) had LBW (< 2500g), and 46/294 (15.7%) were preterm (gestational age < 37weeks). We found no significant differences in laboratory tests, imaging studies (CT), rate of mastoidectomy performed, or late complications between LBW and normal birth weight (NBW) and between preterm and normal gestational age children. LBW children tended to develop AM at an older age compared with NBW children, 2.28 + 1.64 Vs. 1.84 + 1.4years, respectively (p-value = 0.016). Additionally, preterm children were more prone to develop a second event of AM, with a shorter interval between these episodes. LBW and preterm birth are not independent risk factors for disease severity, need for intervention, or future complications in AM. Yet, LBW children present with AM at an older age, and preterm children are more prone for recurrent episodes of AM with a shorter interval between episodes suggesting a distinct disease course in these populations.