Risk factors for COVID‐19‐related mortality in hospitalized children and adolescents with diabetes mellitus: An observational retrospective cohort study

Abstract

Background

Diabetes has been recognized as a major comorbidity for COVID‐19 severity in adults. This study aimed to characterize the clinical outcomes and risk factors for COVID‐19‐related death in a large cohort of hospitalized pediatric patients with diabetes.

Methods

We performed an analysis of all pediatric patients with diabetes and COVID‐19 registered in SIVEP‐Gripe, a Brazilian nationwide surveillance database, between February 2020 and May 2021. The primary outcome was time to death, which was evaluated considering discharge as a competitive risk by using cumulative incidence function.

Results

Among 21,591 hospitalized pediatric patients with COVID‐19, 379 (1.8%) had diabetes. Overall, children and adolescents with diabetes had a higher prevalence of ICU admission (46.6% vs. 26%), invasive ventilation (16.9% vs. 10.3%), and death (15% vs. 7.6%) (all P < 0.0001). Children with diabetes had twice the hazard of death compared with pediatric patients without diabetes (Hazard ratio [HR] = 2.0, 95% CI, 1.58–2.66). Among children with diabetes, four covariates were independently associated with the primary outcome, living in the poorest regions of the country (Northeast, HR, 2.17, 95% CI 1.18–4.01, and North, (HR 4.0, 95% CI 1.79–8.94), oxygen saturation < 95% at admission (HR 2.97, 95% CI 1.64–5.36), presence of kidney disorders (HR 3.39, 95% CI 1.42–8.09), and presence of obesity (HR 3.77, 95% CI 1.83–7.76).

Conclusion

Children and adolescents with diabetes had a higher risk of death compared with patients without diabetes. The higher risk of death was associated with clinical and socioeconomic factors.