Risk factors of COVID-19 related hospitalization of pediatric patients with rheumatic diseases: a systematic review and meta-analysis

Among adults who develop Coronavirus Disease 2019 (COVID-19), those with rheumatic diseases (RDs) have similar hospitalization rates compared with those without RDs. Similar comparisons are lacking in children, due to the overall rarity of COVID-19-related hospitalization in this population. We aimed to examine the risk factors for COVID-19-related hospitalization in pediatric patients with RDs. We conducted a systemic literature search in MEDLINE, EMBASE, Web of Science, and China National Knowledge Infrastructure from December 1, 2019, through January 22, 2024. We included observational studies based on inclusion and exclusion criteria. ORs with 95% confidence intervals (95% CIs) were calculated. Eight cohort studies capturing 1,501 pediatric RD patients with SARS-CoV-2 and 118 COVID-19-related hospitalization were included. Odds of hospitalization was increased in children with RDs compared with healthy children. While the diagnosis of juvenile idiopathic arthritis (JIA) was associated with reduced odds of hospitalization overall (OR 0.43, [95% CI, 0.27-0.68]), systemic JIA was associated with increased odds of hospitalization (OR 2.54, [95% CI, 1.01-6.40]). The use of glucocorticoids (OR 5.36; 95% CI [2.21-13.04]), rituximab (OR 4.62, [95% CI, 1.87-11.40]), mycophenolate (OR 4.17, [95% CI, 1.08-16.16], hydroxychloroquine (OR 2.97, [95% CI, 1.42-6.21], and IL-1-inhibitors (OR 2.28, [95% CI, 1.09-4.78]) were associated with increased odds of hospitalization, while the use of TNFα-inhibitors was associated with reduced odds (OR 0.35, [95% CI, 0.20-0.66]). Children with RDs are at risk of severe COVID-19 outcomes, while children with JIA taking TNFα-inhibitors might be at a lower risk.