COVID-19 Severity in Pediatric Patients Linked to Previous Cardiovascular Conditions

Previous or pre-existing cardiovascular conditions are associated with increased COVID-19 severity in pediatric patients. These findings were published in JAMA Network Open.

The retrospective cohort study used data from Cerner Real-World Data regarding COVID-19-related encounters from 85 US health systems between March 1, 2020, and January 31, 2021.

Participants were aged 2 months to 17 years and had a laboratory-confirmed diagnosis of COVID-19 or a diagnosis code indicating infection or exposure to SARS-CoV-2.

The binary outcome variable was mild vs severe COVID-19. Patients with mild COVID-19 were defined as those who did not receive oxygen therapy and were discharged to home alive. Patients who received oxygen therapy or died in the hospital were defined as those with severe COVID-19.

A total of 171,416 patients were included, of whom 154,351 (90.04%) had mild COVID-19 and 17,065 (9.96%) had severe COVID-19. The participants’ overall median age was 8 years (IQR, 2-14 years), 64.04% were White, and 50.28% were male.

Congenital and acquired cardiovascular conditions were associated with increased odds for severe COVID-19, according to the multivariable mixed-effects model. A history of cardiac arrest was associated with 892% increased odds of severe COVID-19 (odds ratio [OR], 9.92; 95% CI, 6.93-14.20); cardiogenic shock had 207% increased odds (OR, 3.07; 95% CI, 1.90-4.96); heart surgery had 204% increased odds (OR, 3.04; 95% CI, 2.26-4.08); cardiopulmonary disease had 91% increased odds (OR, 1.91; 95% CI, 1.56-2.34); and heart failure had 82% increased odds (OR, 1.82; 95% CI, 1.46-2.26).

Of 258 patients who had previous cardiac arrest, 205 (79.46%) had severe COVID-19, the mortality rate was 27.91%, and 75.19% were aged younger than 12 years. Of 124 patients with a history of cardiogenic shock, the rate of severe COVID-19 was 70.16%, and the mortality rate was 12.10%.

Increased odds of severe COVID-19 also was associated with hypotension (57% increase; OR, 1.57; 95% CI, 1.38-1.79), nontraumatic cerebral hemorrhage (54% increase; OR, 1.54; 95% CI, 1.24-1.91), pericarditis (50% increase; OR, 1.50; 95% CI, 1.17-1.94), and simple biventricular defects (45% increase; OR, 1.45; 95% CI, 1.29-1.62).

Having a cardiovascular condition during a COVID-19-related encounter was associated with a 304% increased odds of severe COVID-19 (OR, 4.04; 95% CI, 3.22-5.07; P <.001).

Among several study limitations, the definition used for classifying COVID-19 severity may not detect patients who developed cardiovascular complications during hospitalization with COVID-19, and newer variants of SARS-CoV-2 have emerged since the end of the study period. In addition, only patients with COVID-19 who sought care at the emergency department, urgent care, or hospital are included.

“The significant associations identified suggest the importance of including children in the populations that are eligible to receive a COVID-19 vaccine after the safety and benefits of vaccination have been established,” the researchers wrote.


Ehwerhemuepha L, Roth B, Patel AK, et al. Association of congenital and acquired cardiovascular conditions with COVID-19 severity among pediatric patients in the USJAMA Netw Open. Published online May 17, 2022. doi: 10.1001/jamanetworkopen.2022.11967

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