Table 3.
Pooled outcomes of the included studies in the subgroup analyses. Subgroup analyses suggested that male sex, underlying conditions (obesity, congenital heart disease, and chronic pulmonary disease), clinical symptoms and complications (ARDS, MIS-C, shortness of breath, gastrointestinal symptoms, and the need for intensive care), and biomarkers (CRP level at baseline) were associated with poor prognosis in children and adolescents with COVID-19. While, there was not statistical significance observed for other factors.
| Risk factor | No. of studies reporting the factor | Total no. of patients | Effect size (95% CI) | I2 | Quality of evidence (GRADE) |
|---|---|---|---|---|---|
| Death | |||||
| Need for intensive care | 1 | 409 | OR 352.46 (20.75, 5985.86) | 100% | LOW |
| Age less than ten years | 2 | 489 | OR 4.56 (1.17, 17.71) | 100% | VERY LOW |
| Admitted to intensive care unit | |||||
| Suspected or confirmed ARDS | 2 | 607 | OR 28.44 (7.61, 106.25) | 16.8% | MODERATE |
| Age less than one month | 3 | 1621 | OR 2.29 (1.48, 3.56) | 0% | LOW |
| Congenital heart disease | 2 | 991 | OR 2.76 (1.04, 7.30) | 0% | LOW |
| Obesity | 2 | 668 | OR 2.42 (1.09, 5.40) | 0% | LOW |
| Gastrointestinal symptoms | 2 | 66 | OR 2.01 (1.29, 3.13) | 0% | LOW |
| Shortness of breath | 1 | 991 | OR 6.27 (1.57, 25.05) | 100% | LOW |
| Male sex | 4 | 1688 | OR 1.34 (1.01, 1.80) | 0% | VERY LOW |
| Underlying conditions | 3 | 1622 | OR 2.83 (1.58, 5.06) | 71.7% | VERY LOW |
| Chronic pulmonary disease | 1 | 582 | OR 3.17 (1.23, 8.22) | 100% | VERY LOW |
| MIS-C | 1 | 409 | OR 2.35 (1.27, 4.34) | 100% | VERY LOW |
| CRP/mg/L (at baseline) | 1 | 66 | WMD 125.80 (37.04, 214.56) | 100% | VERY LOW |
| Receiving respiratory support | |||||
| Shortness of breath | 1 | 435 | OR 16.96 (7.66, 37.51) | 100% | LOW |
| Progression to severe or critical disease | |||||
| Confirmed ARDS | 1 | 98 | OR 56.43 (10.27, 310.00) | 100% | LOW |
We did subgroup analyses for cohort and case-control studies with high and medium quality; OR: odds ratio; WMD: weighted mean difference; CI: confidence interval; ARDS: acute respiratory distress syndrome; CRP: C-reactive protein; GRADE: grading of recommendations assessment, development, and evaluation; MIS-C: multisystem inflammatory syndrome.