TY - JOUR
T1 - Rate of thrombosis in children and adolescents hospitalized with COVID-19 or MIS-C
AU - Whitworth, Hilary
AU - Sartain, Sarah E.
AU - Kumar, Riten
AU - Armstrong, Katherine
AU - Ballester, Lance
AU - Betensky, Marisol
AU - Cohen, Clay T.
AU - Diaz, Rosa
AU - Diorio, Caroline
AU - Goldenberg, Neil A.
AU - Jaffray, Julie
AU - Keegan, Jacquelyn
AU - Malone, Kendra
AU - Randolph, Adrienne G.
AU - Rifkin-Zenenberg, Stacey
AU - Leung, Wendy Seto
AU - Sochet, Anthony
AU - Srivaths, Lakshmi
AU - Zia, Ayesha
AU - Raffini, Leslie
N1 - Funding Information:
This study was supported by National Institutes of Health, National Heart, Lung, and Blood Institute grant T32 HL007971 (H.W.) and a scholarship from the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania (C.D.).
Publisher Copyright:
© 2021 American Society of Hematology
PY - 2021/7/15
Y1 - 2021/7/15
N2 - Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with thrombotic complications in adults, but the incidence of COVID-19-related thrombosis in children and adolescents is unclear. Most children with acute COVID-19 have mild disease, but coagulopathy has been associated with multisystem inflammatory syndrome in children (MIS-C), a postinfectious complication. We conducted a multicenter retrospective cohort study to determine the incidence of thrombosis in children hospitalized with COVID-19 or MIS-C and evaluate associated risk factors. We classified patients into 1 of 3 groups for analysis: COVID-19, MIS-C, or asymptomatic SARS-CoV-2. Among a total of 853 admissions (COVID-19, n = 426; MIS-C, n = 138; and asymptomatic SARS-CoV-2, n = 289) in 814 patients, there were 20 patients with thrombotic events (TEs; including 1 stroke). Patients with MIS-C had the highest incidence (9 [6.5%] of 138) vs COVID-19 (9 [2.1%] of 426) or asymptomatic SARS-CoV-2 (2 [0.7%] of 289). In patients with COVID-19 or MIS-C, a majority of TEs (89%) occurred in patients age ≥12 years. Patients age ≥12 years with MIS-C had the highest rate of thrombosis at 19% (9 of 48). Notably, 71% of TEs that were not present on admission occurred despite thromboprophylaxis. Multivariable analysis identified the following as significantly associated with thrombosis: age ≥12 years, cancer, presence of a central venous catheter, and MIS-C. In patients with COVID-19 or MIS-C, hospital mortality was 2.3% (13 of 564), but it was 28% (5 of 18) in patients with TEs. Our findings may help inform pediatric thromboprophylaxis strategies.
AB - Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with thrombotic complications in adults, but the incidence of COVID-19-related thrombosis in children and adolescents is unclear. Most children with acute COVID-19 have mild disease, but coagulopathy has been associated with multisystem inflammatory syndrome in children (MIS-C), a postinfectious complication. We conducted a multicenter retrospective cohort study to determine the incidence of thrombosis in children hospitalized with COVID-19 or MIS-C and evaluate associated risk factors. We classified patients into 1 of 3 groups for analysis: COVID-19, MIS-C, or asymptomatic SARS-CoV-2. Among a total of 853 admissions (COVID-19, n = 426; MIS-C, n = 138; and asymptomatic SARS-CoV-2, n = 289) in 814 patients, there were 20 patients with thrombotic events (TEs; including 1 stroke). Patients with MIS-C had the highest incidence (9 [6.5%] of 138) vs COVID-19 (9 [2.1%] of 426) or asymptomatic SARS-CoV-2 (2 [0.7%] of 289). In patients with COVID-19 or MIS-C, a majority of TEs (89%) occurred in patients age ≥12 years. Patients age ≥12 years with MIS-C had the highest rate of thrombosis at 19% (9 of 48). Notably, 71% of TEs that were not present on admission occurred despite thromboprophylaxis. Multivariable analysis identified the following as significantly associated with thrombosis: age ≥12 years, cancer, presence of a central venous catheter, and MIS-C. In patients with COVID-19 or MIS-C, hospital mortality was 2.3% (13 of 564), but it was 28% (5 of 18) in patients with TEs. Our findings may help inform pediatric thromboprophylaxis strategies.
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U2 - 10.1182/blood.2020010218
DO - 10.1182/blood.2020010218
M3 - Article
C2 - 33895804
AN - SCOPUS:85105679863
SN - 0006-4971
VL - 138
SP - 190
EP - 198
JO - Blood
JF - Blood
IS - 2
ER -