Severe acute respiratory syndrome coronavirus-2-related and imputable deaths in children: results from the French pediatric national registry

Marguerite Lockhart-Bouron; Noémie Vanel; Michael Levy; Anaïs R Briant; Etienne Javouhey; Sophie Breinig; Julia Dina; Marion Caseris; François Angoulvant; Stéphane Leteurtre; Morgan Recher; David W Brossier

doi:10.1007/s12519-023-00791-x

Severe acute respiratory syndrome coronavirus-2-related and imputable deaths in children: results from the French pediatric national registry

World J Pediatr. 2024 Mar 20. doi: 10.1007/s12519-023-00791-x. Online ahead of print.

Authors

Marguerite Lockhart-Bouron¹, Noémie Vanel², Michael Levy^{3

4}, Anaïs R Briant⁵, Etienne Javouhey⁶, Sophie Breinig⁷, Julia Dina^{8

9}, Marion Caseris¹⁰, François Angoulvant¹¹, Stéphane Leteurtre¹, Morgan Recher¹, David W Brossier^{12

13

14

15}

Affiliations

¹ Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France.
² Pediatric Intensive Care Unit, CHU de Marseille, Marseille, France.
³ Pediatric Intensive Care Unit, CHU Robert-Debré, Assistance Publique Hôpitaux de Paris, Paris, France.
⁴ Université Paris-Cité, Paris, France.
⁵ Biostatistics and Clinical Research Unit, CHU de Caen Normandie, 14000, Caen, France.
⁶ Pediatric Intensive Care, Hospices Civils de Lyon, Lyon, France.
⁷ Neonatal and Pediatric Intensive Care Unit, Children's Hospital, Toulouse, France.
⁸ Virology Department, INSERM U1311 Dynamicure, Univ CAEN Normandie, CHU de Caen, 14000, Caen, France.
⁹ Medical School, Université Caen Normandie, 14000, Caen, France.
¹⁰ Department of Pediatrics, CHU Robert-Debré, Assistance Publique Hôpitaux de Paris, Paris, France.
¹¹ Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
¹² Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France. brossier-d@chu-caen.fr.
¹³ Medical School, Université Caen Normandie, 14000, Caen, France. brossier-d@chu-caen.fr.
¹⁴ Pediatric Intensive Care Unit, Réanimation Et Soins Intensifs Pédiatriques, CHU de CAEN, Avenue de La Côte de Nacre, 14000, Caen, France. brossier-d@chu-caen.fr.
¹⁵ CHU Sainte Justine Research Center, Montréal, Canada. brossier-d@chu-caen.fr.

PMID: 38506979
DOI: 10.1007/s12519-023-00791-x

Abstract

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for an important mortality rate worldwide. We aimed to evaluate the actual imputability of SARS-CoV-2 on the mortality rate associated with SARS-CoV-2-related illnesses in the pediatric intensive care unit (PICU). Secondary objectives were to identify risk factors for death.

Methods: This national multicenter comparative study comprised all patients under 18 years old with positive SARS-CoV-2 polymerase chain reactions (PCRs) [acute corona virus disease 2019 (COVID-19) or incidental SARS-CoV-2 infection] and/or pediatric inflammatory multisystem syndrome (PIMS) recorded in the French PICU registry (PICURe) between September 1, 2021, and August 31, 2022. Included patients were classified and compared according to their living status at the end of their PICU stay. Deceased patients were evaluated by four experts in the field of pediatric infectiology and/or pediatric intensive care. The imputability of SARS-CoV-2 as the cause of death was classified into four categories: certain, very probable, possible, or unlikely, and was defined by any of the first three categories.

Results: There were 948 patients included of which 43 died (4.5%). From this, 26 deaths (67%) could be attributed to SARS-CoV-2 infection, with an overall mortality rate of 2.8%. The imputability of death to SARS-CoV-2 was considered certain in only one case (0.1%). Deceased patients suffered more often from comorbidities, especially heart disease, neurological disorders, hematological disease, cancer, and obesity. None of the deceased patients were admitted for pediatric inflammatory multisystem syndrome (PIMS). Mortality risk factors were male gender, cardiac comorbidities, cancer, and acute respiratory distress syndrome.

Conclusions: SARS-CoV-2 mortality in the French pediatric population was low. Even though the imputability of SARS-CoV-2 on mortality was considered in almost two-thirds of cases, this imputability was considered certain in only one case.

Keywords: Death; Pediatric intensive care unit; SARS-CoV-2.