Table 2.
Summary of findings and quality of evidence for severity of viral coinfections versus single infections in children.
| Outcomes | No of Participants (studies) | Quality of the evidence (GRADE) |
Relative effect (95% CI) |
Anticipated absolute effects |
|
|---|---|---|---|---|---|
| Risk with Single infection | Risk difference with viral coinfection (95% CI) | ||||
| Length of stay | 3548 (24 studies) | ⊕⊕⊕⊝ MODERATEa,b,c,d,e due to indirectness |
The mean length of stay in viral coinfection group was 0.1 lower (0.51 lower to 0.31 higher) | ||
| Death | 2296 (7 studies) | ⊕⊝⊝⊝ VERY LOWe,f,g,h,i due to risk of bias, inconsistency, imprecision |
OR 2.22 (0.83–5.95) |
26 per 1000 | 30 more per 1000 (from 4 fewer to 111 more) |
| Need of hospitalization | 9637 (11 studies) | ⊕⊕⊕⊝ MODERATEe,g,j,k,ldue to inconsistency |
OR 0.96 (0.61–1.51) |
749 per 1000 | 8 fewer per 1000 (from 104 fewer to 69 more) |
| Need of mechanical ventilation | 492 (3 studies) | ⊕⊕⊝⊝ LOWb,e,i,m,n due to indirectness, imprecision |
OR 0.81 (0.33–2.01) |
63 per 1000 | 11 fewer per 1000 (from 41 fewer to 56 more) |
| Length of supplemental oxygen | 674 (5 studies) | ⊕⊕⊕⊝ MODERATEc,d,e,o,pdue to risk of bias |
The mean length of supplemental oxygen in viral coinfection group was 0.42 lower (1.05 lower to 0.2 higher) | ||
| Need of supplemental oxygen | 2285 (12 studies) | ⊕⊕⊝⊝ LOWe,g,l,q,r due to inconsistency, indirectness |
OR 0.94 (0.66–1.34) | 512 per 1000 | 15 fewer per 1000 (from 103 fewer to 72 more) |
| Need of PICU | 2630 (11 studies) | ⊕⊕⊕⊝ MODERATEe,g,l,s,t due to inconsistency |
OR 0.99 (0.64–1.54) | 220 per 1000 | 2 fewer per 1000 (from 67 fewer to 83 more) |
Note: CI: Confidence interval; OR: Odds ratio;
GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.
Sixteen of twenty four included studies have no substantial risk of bias. The remaining eight have problems due to potential selection bias and/or failures to report or control of confounders.
No serious inconsistency was found.
In sixteen included studies, comparison was based upon specific viral combinations.
Optimal sample size for detecting a difference of 1 day (alpha 0.05 and power of 80%) was met and null hypothesis, which was considered the most plausible, was met.
No substantial publications bias was detected.
Four of included studies have failures to report or control of confounders.
High statistical heterogeneity (p < 0.01 and/or I2 > 50%) was found.
In four included studies, comparison was based upon all viral coinfections and all single infections.
Optimal information size was not achieved and 95% confidence interval was wide.
Eight included studies have no substantial risk of bias. The remaining three have failure to report or control of confounders.
In seven included studies, comparison was based upon all viral coinfections and all single infections.
Optimal sample size was met and 95% confidence interval was narrow and included null effect, which was considered most plausible hypothesis.
No serious risk of bias was found in most of bias domains of included studies.
In two included studies, comparison was based upon specific viral combinations.
Three included studies have a substantial risk of bias due to selection bias and/or failure to report or control of confounders.
In three included studies, comparison was based upon all viral coinfections and all single infections.
Eight studies have no substantial risk of bias. The remaining four have failure to report or control of confounders.
In half of included studies, comparison was based upon specific viral combinations.
Six included studies have no substantial risk of bias. The remaining five have failure to report or control of confounders.
In nine included studies, comparison was based upon all viral coinfections and all single infections.