Mortality in children with positive SARS-CoV-2 polymerase chain reaction test: Lessons learned from a tertiary referral hospital in Indonesia

• Main Authors: Rismala Dewi, Nastiti Kaswandani, Mulya Rahma Karyanti, Darmawan Budi Setyanto, Antonius Hocky Pudjiadi, Aryono Hendarto, Mulyadi M. Djer, Ari Prayitno, Irene Yuniar, Wahyuni Indawati, Yogi Prawira, Setyo Handryastuti, Hikari Ambara Sjakti, Eka Laksmi Hidayati, Dina Muktiarti, Amanda Soebadi, Niken Wahyu Puspaningtyas, Riski Muhaimin, Anisa Rahmadhany, Gilbert Sterling Octavius, Henny Adriani Puspitasari, Madeleine Ramdhani Jasin, Tartila Tartila, Nina Dwi Putri
• Format: Article
• Language: English
• Published: Elsevier 2021-06-01
• Series: International Journal of Infectious Diseases
• Subjects: COVID-19; SARS-CoV-2; Outcome; Children; Indonesia
• Online Access: http://www.sciencedirect.com/science/article/pii/S1201971221003301

Background: The incidence of coronavirus disease 2019 (COVID-19) is still increasing rapidly, but little is known about the prevalence and characteristics of fatal cases in children in Indonesia. This study aimed to describe the characteristics of children with COVID-19 with fatal outcomes in a tertiary referral hospital in Indonesia. Methods: This cross-sectional study used data collected from the medical records of patients with COVID-19 admitted to Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia from March to October 2020. Results: During the study period, 490 patients were admitted and diagnosed with suspected and probable COVID-19. Of these patients, 50 (10.2%) were confirmed to have COVID-19, and 20 (40%) had a fatal outcome. The fatality rate was higher in patients aged ≥10 years, categorized with severe disease upon admission, PaO2/FiO2 ratio ≤300 mmHg and chronic underlying diseases. The most common clinical manifestations were generalized symptoms, while acute respiratory distress syndrome (8/20) and septic shock (7/20) were the two most common causes of death. Increased procalcitonin, D-dimer, lactate dehydrogenase and presepsin levels were found in all fatal cases. One patient met the criteria of multisystem inflammatory syndrome in children. Conclusion: Our work highlights the high mortality rate in paediatric patients with positive SARS-CoV-2 polymerase chain reaction test. These findings might be related to or co-incided with COVID-19 infection. Further studies are needed to improve understanding of the role of severe acute respiratory syndrome coronavirus-2 in elaborating the mechanisms leading to death in children with comorbidities.