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Neurological manifestations and risk factors associated with poor prognosis in hospitalized children with Omicron variant infection

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Abstract

There are increasing reports of neurological manifestation in children with coronavirus disease 2019 (COVID-19). However, the frequency and clinical outcomes of in hospitalized children infected with the Omicron variant are unknown. The aim of this study was to describe the clinical characteristics, neurological manifestations, and risk factor associated with poor prognosis of hospitalized children suffering from COVID-19 due to the Omicron variant. Participants included children older than 28 days and younger than 18 years. Patients were recruited from December 10, 2022 through January 5, 2023. They were followed up for 30 days. A total of 509 pediatric patients hospitalized with the Omicron variant infection were recruited into the study. Among them, 167 (32.81%) patients had neurological manifestations. The most common manifestations were febrile convulsions (n = 90, 53.89%), viral encephalitis (n = 34, 20.36%), epilepsy (n = 23, 13.77%), hypoxic-ischemic encephalopathy (n = 9, 5.39%), and acute necrotizing encephalopathy (n = 6, 3.59%). At discharge, 92.81% of patients had a good prognosis according to the Glasgow Outcome Scale (scores ≥ 4). However, 7.19% had a poor prognosis. Eight patients died during the follow-up period with a cumulative 30-day mortality rate of 4.8% (95% confidence interval (CI) 1.5–8.1). Multivariate analysis revealed that albumin (odds ratio 0.711, 95% CI 0.556–0.910) and creatine kinase MB (CK-MB) levels (odds ratio 1.033, 95% CI 1.004–1.063) were independent risk factors of poor prognosis due to neurological manifestations. The area under the curve for the prediction of poor prognosis with albumin and CK-MB was 0.915 (95%CI 0.799–1.000), indicating that these factors can accurately predict a poor prognosis.

          Conclusion: In this study, 32.8% of hospitalized children suffering from COVID-19 due to the Omicron variant infection experienced neurological manifestations. Baseline albumin and CK-MB levels could accurately predict poor prognosis in this patient population.

What is Known:

• Neurological injury has been reported in SARS-CoV-2 infection; compared with other strains, the Omicron strain is more likely to cause neurological manifestations in adults.

• Neurologic injury in adults such as cerebral hemorrhage and epilepsy has been reported in patients with Omicron variant infection.

What is New:

• One-third hospitalized children with Omicron infection experience neurological manifestations, including central nervous system manifestations and peripheral nervous system manifestations.

• Albumin and CK-MB combined can accurately predict poor prognosis (AUC 0.915), and the 30-day mortality rate of children with Omicron variant infection and neurological manifestations was 4.8%.

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Data availability

No datasets were generated or analyzed during the current study.

Abbreviations

ALT:

Alanine aminotransferase

ARDS:

Acute respiratory distress syndrome

AST:

Aspartate aminotransferase

AUC:

Area under the curve

BUN:

Blood urea nitrogen

CK-MB:

Creatine kinase-MB form

CNS:

Central nervous system

COVID-19:

Coronavirus disease 2019

ECMO:

Extracorporeal membrane oxygenation

GOS:

Glasgow Outcome Scale

NLR:

Neutrophil-to-lymphocyte ratio

OR:

Odds ratio

PCT:

Procalcitonin

PNS:

Peripheral nervous system

ROC:

Receiver operating characteristics

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus 2

TB:

Total bilirubin

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Author notes

  1. Li Tang, Yuxin Guo and Chang Shu contributed equally to this work.

Authors and Affiliations

  1. Department of Infectious Diseases, Xi’an Jiaotong University Affiliated Children’s Hospital, No. 69 Xi Ju Yuan Alley, Xi’an, 710003, Shaanxi, China

    Li Tang, Chang Shu, Xiaokang Peng, Ruina Li, Pan Liu, Huijing Wei, Shan Liao, Yali Du, Dandan Guo & Xiaoguai Liu

  2. Department of Infectious Diseases, the Second Affiliated Hospital Xi’an Jiaotong University, No.157 Xi Wu Road, Xi’an, 710004, Shaanxi, China

    Yuxin Guo, Sikai Qiu, Ning Gao & Fanpu Ji

  3. Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, No. 1, Eastern Jianshe Road, Zhengzhou, 450052, Henan, China

    Qing-Lei Zeng

  4. Key Laboratory of Environment and Genes Related to Diseases (Xi’an Jiaotong University) Ministry of Education of China, Xi’an, China

    Fanpu Ji

  5. National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China

    Fanpu Ji

  6. Shaanxi Provincial Clinical Medical Research Center of Infectious Diseases, Xi’an, Shaanxi, China

    Fanpu Ji

  7. Key Laboratory of Surgical Critical Care and Life Support (Xi’an Jiaotong University), Ministry of Education, Shaanxi, China

    Fanpu Ji

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  1. Li Tang
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Contributions

Study conception and study supervision: QLZ, XL, FJ Study design: XL, FJ Statistical analysis: LT, YG, CS Data interpretation: all authors Manuscript preparation: LT, YG, CS, QLZ, NG Manuscript review: QLZ, FJ Approval the manuscript: all authors.

Corresponding authors

Correspondence to Qing-Lei Zeng, Xiaoguai Liu or Fanpu Ji.

Ethics declarations

Ethics approval

This is an observational study. The Xi'an Jiaotong University Affiliated Children’s Hospital Research Ethics Committee and the Second Affiliated Hospital Xi'an Jiaotong University Research Ethics Committee have confirmed that no ethical approval is required.

Consent to participate

All presentations of case reports had consent for publication of their clinical details and/or clinical images which were obtained from the parent/guardian of the patient.

Competing interests

QLZ: Speaker: Gilead and Abbott. Consulting/advisory board: Gilead. FJ: Speaker: Gilead Sciences, MSD and Ascletis. Consulting/advisory board: Gilead, MSD. All other authors do not have conflict of interest.

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Tang, L., Guo, Y., Shu, C. et al. Neurological manifestations and risk factors associated with poor prognosis in hospitalized children with Omicron variant infection. Eur J Pediatr 183, 2353–2363 (2024). https://doi.org/10.1007/s00431-024-05495-6

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