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

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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.

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Data availability

All data that support the findings of this study will be available from the corresponding author upon reasonable request.

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Acknowledgements

We are grateful to Groupe Francophone de Réanimation et d’Urgences Pédiatriques, Santé Publique France. PICURe-GFRUP study group*: Mickael Afanetti, MD, (Nice), Julien Baleine, MD, (Montpellier), Sebastien Barthelemy, MD, (Nice), Jean Bergounioux, MD, PhD, (Garches), Renaud Blondé, MD, (Mamoudzou), Benoit Bœuf, MD, (Clermont-Ferrand), Noel Boussard, MD, (Nancy), Gerald Boussicault, MD, (Angers), Roselyne Brat, MD, (Orléans), Olivier Brissaud, MD, PhD, (Bordeaux), Julie Chantreuil, MD, (Tours), Camille Chavy, MD, (Dijon), Emmanuel Couadau, MD, (Nouméa), Thibaud Dabudyk, MD, (Besançon), Etienne Darrieux, MD, (Saint Pierre), Stéphane Dauger, MD, PhD (Paris Robert-Debré), Jean-Marie De Guillebon De Resnes, MD, (Nice), Émeline Gabilly-Benard, MD, (Poitiers), Sophie Galene Gromez, MD, (Rouen), Armelle Garenne, MD, (Brest), Ghida Ghostine, MD, (Amiens), Charlene Grabot, MD, (Fort de France), Anne-Sophie Guilbert, MD, (Strasbourg), Aurélie Hayotte, MD, (Paris Robert-Debré), Silvia Lacobelli, MD, (Saint-Pierre), Mikaël Jokic, MD, (Caen), Nicolas Joram, MD, (Nantes), Aurelie Labarre, MD, (Rouen), Marie Lampin, MD, (Lille), Pierre-Louis Leger, MD, PhD, (Paris Trousseau), Marc Lilot, MD, (Lyon), Gauthier Loron, MD, (Reims), Emilien Maisonneuve, MD, (Grenoble), Arielle Maroni, MD, (Paris Robert-Debré), Christophe Milési, MD, PhD, (Montpellier), Fabrice Michel, MD, PhD, (Marseille), Juliette Montmayeur, MD, (Paris Necker-Enfants-Malades), Jérôme Naudin, MD, (Paris Robert-Debré), Paul Nolent, MD, (Bordeaux), Karine Norbert, MD, (Pau), Gilles Orliaguet, MD, PhD, (Paris Necker-Enfants-Malades), Mehdi Oualha, MD, PhD, (Paris Necker-Enfants-Malades), Bruno Ozanne, MD, (Rennes), Hugues Patural, MD, PhD, (Saint-Etienne), Sonia Pelluau, MD, (Toulouse), Jérôme Pignol, MD, (Fort de France), Laure Ponthier, MD, (Limoges), Amandine Prenant, MD, (Angers), Sylvain Renolleau, MD, PhD, (Paris Necker-Enfants-Malades), Lila Robin, MD, (Orléans), Charlotte Roulland, MD, (Caen), Nicolas Roullet-Renoleau, MD, (Tours), Emilie Ruiz, MD, (Poitiers), Iona Sicard-Cras, MD, (Brest), Gerard Thiriez, MD, PhD, (Besançon), Fabrice Ughetto MD, (Marseille), Florence Villedieu, MD, (Caen), Arnaud Wiedemann, MD, PhD, (Nancy), Lorenco Xavier, MD, (Nouméa), Justine Zini, MD, (Garches).

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Authors and Affiliations

  1. Univ. Lille, CHU Lille, ULR 2694 – METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France

    Marguerite Lockhart-Bouron, Stéphane Leteurtre, Morgan Recher & David W. Brossier

  2. Pediatric Intensive Care Unit, CHU de Marseille, Marseille, France

    Noémie Vanel

  3. Pediatric Intensive Care Unit, CHU Robert-Debré, Assistance Publique Hôpitaux de Paris, Paris, France

    Michael Levy

  4. Université Paris-Cité, Paris, France

    Michael Levy

  5. Biostatistics and Clinical Research Unit, CHU de Caen Normandie, 14000, Caen, France

    Anaïs R. Briant

  6. Pediatric Intensive Care, Hospices Civils de Lyon, Lyon, France

    Etienne Javouhey

  7. Neonatal and Pediatric Intensive Care Unit, Children’s Hospital, Toulouse, France

    Sophie Breinig

  8. Virology Department, INSERM U1311 Dynamicure, Univ CAEN Normandie, CHU de Caen, 14000, Caen, France

    Julia Dina

  9. Medical School, Université Caen Normandie, 14000, Caen, France

    Julia Dina & David W. Brossier

  10. Department of Pediatrics, CHU Robert-Debré, Assistance Publique Hôpitaux de Paris, Paris, France

    Marion Caseris

  11. Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital (CHUV), Lausanne, Switzerland

    François Angoulvant

  12. Pediatric Intensive Care Unit, Réanimation Et Soins Intensifs Pédiatriques, CHU de CAEN, Avenue de La Côte de Nacre, 14000, Caen, France

    David W. Brossier

  13. CHU Sainte Justine Research Center, Montréal, Canada

    David W. Brossier

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  1. Marguerite Lockhart-Bouron
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  2. Noémie Vanel
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  3. Michael Levy
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Contributions

MLB, NV: methodology, validation, investigation, writing–original draft. ML, MR: conceptualization, methodology, writing–review and editing. ARB: formal analysis, writing–review and editing. EJ, SB, JD, MC: Investigation, Writing–Review and Editing. FA: onceptualization, writing–review and editing. SL: conceptualization, methodology, writing–review and editing, supervision. DB: conceptualization, methodology, validation, formal analysis, data curation, writing–review and editing, supervision.

Corresponding author

Correspondence to David W. Brossier.

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Conflicts of interest

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

Ethical approval

The Local Research Ethics Committee for health research of the University Hospital of CAEN approved our protocol on May 16, 2022 (ID 3456). This study was part of the official public health activity (Ministry of Solidarity and Health) and was approved as a medical registry assessment without the requirement for patient consent by the French Advisory Committee on Information Processing in Health Research.

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Lockhart-Bouron, M., Vanel, N., Levy, M. et al. Severe acute respiratory syndrome coronavirus-2-related and imputable deaths in children: results from the French pediatric national registry. World J Pediatr (2024). https://doi.org/10.1007/s12519-023-00791-x

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