Risk factors for poor prognosis in children and adolescents with COVID-19: A systematic review and meta-analysis

Background: This study provides the first systematic review and meta-analysis to identify the predictors of unfavorable prognosis of COVID-19 in children and adolescents.Methods: We searched literature databases until July 2021 for studies that investigated risk factors for unfavorable prognosis of children and adolescents with COVID-19.We used random-effects models to estimate the effect size with 95% confidence interval (CI).Findings: We identified 56 studies comprising 79,104 individuals.Mortality was higher in patients with multisystem inflammatory syndrome (MIS-C) (odds ratio [OR]=58.00,95% CI 6.39À526.79)and who were admitted to intensive care (OR=12.64,95% CI 3.42À46.68).Acute respiratry distress syndrme (ARDS) (OR=29.54,95% CI 12.69À68.78)and acute kidney injury (AKI) (OR=55.02,95% CI 6.26À483.35)increased the odds to be admitted to intensive care; shortness of breath (OR=16.96,95% CI 7.66À37.51)increased the need of respiratory support; and neurological diseases (OR=5.16,95% CI 2.30À11.60),C-reactive protein (CRP) level 80 mg/ L (OR=11.70,95% CI 4.37À31.37)and D-dimer level 0.5ug/mL (OR=20.40,95% CI 1.76À236.44)increased the odds of progression to severe or critical disease.Interpretation: Congenital heart disease, chronic pulmonary disease, neurological diseases, obesity, MIS-C, shortness of breath, ARDS, AKI, gastrointestinal symptoms, elevated CRP and D-dimer are associated with unfavourable prognosis in children and adolescents with COVID-19.