BACKGROUND: The clinical features and risk factors of post‑acute sequelae of SARS‑CoV‑2 infection (PASC) in children remain incomplete. This study aims to identify risk factors and evaluate the predictive utility of a clinical scoring system for PASC in pediatric patients previously hospitalized for COVID‑19.
METHODS: We conducted a combined retrospective and prospective cohort study at the China Medical University Children's Hospital in Taiwan, including 143 children aged 3-18 hospitalized for the acute COVID-19 during the Omicron pandemic from April 2022 to July 2023. PASC was assessed through phone calls, online survey, and in-person follow-ups. Data encompassing demographics, clinical presentations, laboratory results, and acute-phase treatment were collected and compared between children with and without PASC. Each child was assigned total clinical scores based on the acute-phase symptoms and treatment. Multivariable logistic regression was used to identify independent predictors and evaluate the model's performance using the area under the receiver operating characteristic curve (AUC).
RESULTS: Among the 143 discharged children, 35.7% (n = 51) developed PASC. Children with PASC had significantly longer fever duration (3.2 vs. 2.6 days, p = 0.03), lower viral loads (higher RT-PCR Ct values: 17.1 vs. 14.2, p = 0.03) and higher rates of antiviral therapy (19.6% vs. 6.5%, p = 0.02) during the acute phase compared to those without PASC. There were no differences in age, body weight, other laboratory parameters, length of intensive care unit (ICU) stay, bacterial coinfections, and oxygen supplementation between the two groups. Notably, compared to the non-PASC group, the total clinical scores were significantly higher in the PASC group (37.9 vs. 31.5, p = 0.02). After adjusting for covariates, the multivariable prediction model achieved an AUC of 0.84.
CONCLUSIONS: This study identified a significant proportion of children developing PASC following hospitalization for acute COVID-19. Longer fever duration, low viral load (high Ct values) and antiviral therapy during the acute phase emerged as potential risk factors. Moreover, the multivariable prediction model and the clinical scoring system may support post-discharge risk stratification and help prioritize follow-up in children hospitalized for COVID-19.
CLINICAL TRIAL NUMBER: Not applicable.
