Preexisting CV Conditions May Increase COVID-19 Severity Among Pediatric Patients

Louis Ehwerhemuepha, PhD

Some previous or preexisting cardiovascular conditions were found to be associated with increased COVID-19 severity among pediatric patients in the United States, according to new findings.

The magnitude of these associations in the study varied across the 26 cardiovascular conditions studied, but suggested a high overall cardiovascular burden associated with severe COVID-19, noted the study investigators.

“The data presented in this study highlight the need for pediatric health care professionals to provide careful monitoring and timely care to pediatric patients with preexisting cardiovascular disease and SARS-CoV-2 infection,” wrote corresponding author Louis Ehwerhemuepha, PhD, Children’s Health of Orange County.

Despite limits on early data relating to pediatric COVID-19 cases, systematic reviews found that underlying cardiovascular defects were prevalent, with congenital heart disease (CHD) associated with poor clinical outcomes. The current study evaluated cardiovascular factors associated with severe COVID-19 in pediatrics and to estimate corresponding odds ratios (ORs).

Investigators hypothesized substantial differences in the magnitude of the ORs among cardiovascular factors associated with severe COVID-19 that may translate to clinically useful information for the treatment of these patients. Their study used data on COVID-19-related encounters from 85 health systems between March 2020 - January 2021 from a large, electronic health records database in the US.

Its cohort consisted of patients between 2 months and 17 years of age who had a laboratory-confirmed diagnosis of COVID-19 or a diagnosis code indicating infection or exposure to SARS-CoV-2. Investigators identified 26 cardiovascular conditions for a comprehensive list of congenital and acquired conditions affecting the cardiovascular system.

A binary outcome variable of mild versus severe COVID-19 outcome was defined by investigators. Those who received oxygen therapy and discharged to home alive were defined as having mild COVID-19, while those who received oxygen therapy or died in the hospital were defined as having severe COVID-19.

They noted mixed-effects, random intercept logistic regression modeling assessed the significance and magnitude of associations between 26 cardiovascular conditions and COVID-19 severity.

A total of 171,416 pediatric patients from 85 health systems were found to meet inclusion criteria, with a mean age of 8 years and 50.28% male patients. From these patients, 17,065 (9.96%) had severe COVID-19.

The random intercept model reported that the following cardiovascular conditions were associated with severe COVID-19:

• cardiac arrest (OR, 9.92; 95% CI, 6.93 - 14.20)
• cardiogenic shock (OR, 3.07; 95% CI, 1.90 - 4.96)
• heart surgery (OR, 3.04; 95% CI, 2.26 - 4.08)
• cardiopulmonary disease (OR, 1.91; 95% CI, 1.56 - 2.34)
• heart failure (OR, 1.82; 95% CI, 1.46 - 2.26)
• hypotension (OR, 1.57; 95% CI, 1.38 - 1.79)
• nontraumatic cerebral hemorrhage (OR, 1.54; 95% CI, 1.24 - 1.91)
• pericarditis (OR, 1.50; 95% CI, 1.17 - 1.94)
• simple biventricular defects (OR, 1.45; 95% CI, 1.29 - 1.62)

From the 258 patients with previous cardiac arrest, a total of 205 (79.46%) had severe COVID-19, with a mortality rate of 27.91% (n = 72 deaths). Investigators noted 194 of these patients (75.19%) with previous cardiac arrest were younger than 12 years.

Furthermore, the diagnosis of a cardiovascular condition during a COVID-19-related encounter was associated with a 204% increase in the odds of severe COVID-19 (OR, 4.04; 95% CI, 3.22 - 5.07; P <.001).

The study, “Association of Congenital and Acquired Cardiovascular Conditions with COVID-19 Severity Among Pediatric Patients in the US,” was published in JAMA Network Open.