Persistent symptoms after 1 year in hospitalized children with acute COVID-19 compared to other conditions

Persistent symptoms after 1 year in hospitalized children with acute COVID-19 compared to other conditions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Persistent symptoms after 1 year in hospitalized children with acute COVID-19 compared to other conditions Alfredo Tagarro, Marta Conde, Irati Gastesi, Lucía de Pablo, Sara Villanueva, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4582926/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose We evaluated the prevalence and characteristics of persistent signs and/or symptoms in children and young people (CYP) one year after hospitalization for acute COVID-19 compared with a control group of CYP hospitalized for other conditions. Methods We conducted an observational study in three hospitals in Madrid. We included a group of children who aged 1 month to 18 years of age who were hospitalized for acute COVID-19 from March 2020 to December 2021. We selected a group of patients for comparison among hospitalized patients the same month as the participants with COVID-19, for different reasons, with no history of COVID-19 at recruitment or during follow-up. Data were collected from clinical records and a standardized questionnaire answered by families. The primary outcome was the presence of persistent symptoms one year after hospitalization. Results Ninety-six patients were enrolled and analyzed (50 acute COVID-19 patients and 46 non-COVID-19 participants). The definition of persistent symptoms was met in 34/96 (35%) CYP: 17/50 (34%) COVID-19 participants and 17/46 (37%) non-COVID-19 participants (p=0.767). Symptoms persisted ³12 months in 14/50 (28%) COVID-19 participants and in 7/46 (15%) non-COVID-19 participants (p=0.140). Both groups rated similarly before and after admission on all the specific items related to emotional welfare, social relationships, and current activities. Readmissions occurred in 11/50 (22%) COVID-19 participants and in 6/46 (13%) non-COVID-19 participants (p=0.267). Conclusion : This study found a non-significant difference in the prevalence of persistent symptoms 1 year after hospitalization between children and young people (CYP) with acute COVID-19 and those hospitalized for other reasons. Post-Acute COVID-19 Syndrome children COVID-19 SARS-CoV-2 chronic fatigue disorder Figures Figure 1 What is known? Numerous COVID-19 patients experience enduring physical, cognitive, and mental health issues lasting over three months post-infection, referred to as long COVID or post-COVID-19 condition. What is knew? The prevalence of persistent symptoms one year after hospitalization was high, but not significantly different between hospitalized CYP with COVID-19 and non-COVID-19 participants hospitalized for other conditions. Persistent symptoms may be common in hospitalized children and vary according to the reason for hospitalization. Introduction Much attention has been focused on the persistent symptoms following coronavirus disease (COVID-19), termed post-acute sequelae of COVID-19 (PASC), long COVID, or post-COVID condition. The prevalence in the pediatric population ranges from 1.7% to 70%.[1, 2] Previous hospitalization has been associated in adults with an increased risk of PASC (odds ratio [OR], 2.48; 95%CI, 1.97 ; 3.13). [3] Our understanding of this condition is hampered by the paucity of case–control studies, particularly in the pediatric population. We evaluated the prevalence and characteristics of persistent signs and/or symptoms in children and young people (CYP) one year after hospitalization for acute COVID-19 compared with a control group of CYP hospitalized for other conditions, assessing whether COVID-19, and associated interventions, confers any additional risk of persistent symptoms beyond any risk conferred by being hospitalised and the interventions received there. Methods We conducted an observational study in three hospitals in Madrid, Spain (Hospital Universitario 12 de Octubre (HU12O), Hospital Universitario Gregorio Marañón (HUGM), and Hospital Universitario Infanta Sofía (HUIS), nested in a prospective, observational cohort––the Epidemiological Study of COVID-19 (EPICO). We included a group of children who aged 1 month to 18 years of age who were hospitalized for acute COVID-19 from March 2020 to December 2021 and included in the EPICO cohort. Patients with multisystem inflammatory syndrome in children were excluded. We selected a group of patients for comparison among hospitalized patients at HUIS and HU12O the same month as the participants with COVID-19, for different reasons, including acute medical and surgery-related reasons, who tested negative for COVID-19 at admission, and with no reported or recorded history of COVID-19 at recruitment or during follow-up. COVID-19 group, and comparison group patients were matched 1:1 by month of admission, sex, and age group ( 10 years). The causes of admission of the comparison group are shown in Supplementary Table S1. Two components were carried out for this study. Firstly, a questionnaire was adapted from the ISARIC questionnaire (available on request). [4] Data were collected from clinical records on participants’ initial hospitalization, new diagnoses after hospitalization, time of diagnosis and current situation, and readmission. Secondly, families were contacted by telephone, and a standardized questionnaire was administered from March 2022 to November 2022, at least one year after the admission of each participant. The questionnaire could be answered online by the caregiver or by telephone interview with research staff. CYP could participate in completing the form at the discretion of the caregiver. The questionnaire included sections on emotional welfare, social relationships, and activities compared before and after admission, and a section related to current and past physical health. All data were collected using REDCap electronic data collection tools. [5] A specific informed consent was prepared for non-COVID-19 patients, participants with COVID-19 provided consent at enrolment. The study was approved by the relevant Ethics Committee (code 20/101). Persistent symptoms were defined as the development or continuation of new symptoms three months after the initial infection, with these symptoms lasting for at least two months without explanation. [6] The primary outcome was the presence of persistent symptoms one year after hospitalization. The secondary outcome was parental perception of mood and behavioral changes in CYP. Statistical methods We extracted baseline socio-demographic and clinical characteristics to describe the study population, and data are presented for all participants and summarized by group. Continuous variables were tested for normality using the Shapiro-Wilk test and were reported as mean and standard deviation (SD) when normally distributed and as median and interquartile range (IQR) if non-normally distributed. Categorical variables were summarized as frequency counts and percentages. The denominator for each percentage was the number of subjects within the population group without excluding missing observations, unless otherwise stated. Chi-squared test and Fisher’s test were used to test for differences between groups, as appropriate. Student’s t-test was used for normally distributed continuous variables, and non-parametric tests (Mann-Whitney U test or Kruskal-Wallis) were used for non-normally distributed data. All hypothesis tests were performed at the 5% significance level, and p-values were rounded to three decimal places. In summary tables, p-values less than 0.001 are reported as <0.001 as implemented in the compare Groups R package. [7]. A linear regression analysis and Pearson correlation test were employed to evaluate the strength and direction of the association between physical symptoms (independent variable) and emotional symptoms (dependent variable), quantifying the linear dependency between these two variables. A multivariate logistic model was developed to assess the risk factors associated with the development of persistent symptoms. The model included demographic characteristics (sex at birth and age) and comorbidities (neurological conditions, gastrointestinal problems, heart diseases, respiratory diseases, asthma, eczema, food allergies, other endocrine illnesses, renal problems, excessive weight, and obesity), as well as variables for admission time, severe disease and COVID-19 vaccination. The results were summarized using ORs with 95% confidence intervals. Variables were selected according to the Akaike Information Criterion (AIC) using the forward selection method. To avoid loss of information and statistical power in the association analysis, missing data will be imputed using a non-parametric random forest imputation algorithm. To prevent too many assumptions, only variables with less than 20% of missing information will be considered for imputation the other variables will be treated as complete cases without considering missing information. Missing observations were balanced between both groups. Results Ninety-six patients were enrolled and analyzed (50 acute COVID-19 patients and 46 non-COVID-19 participants) after excluding four patients due to incomplete data. Fifty-seven patients (58.3%) were male at birth. No differences were found in baseline characteristics between COVID-19 participants and non-COVID-19 participants (Table 1). Families were interviewed at a median of 1.89 years (IQR, 1.25-2.07) after hospitalization. The definition of persistent symptoms was met in 34/96 (35%) CYP: 17/50 (34%) COVID-19 participants and 17/46 (37%) non-COVID-19 participants (p=0.767). Symptoms persisted ³12 months in 14/50 (28%) COVID-19 participants and in 7/46 (15%) non-COVID-19 participants (p=0.140). Non-COVID-19 participants were more likely to present with only one persistent symptom (9/46, 20% vs. 1/50, 2% of COVID-19 participants), but the difference decreased ³12 months after hospitalization (2/46, [4%] vs 1/50, [2%] of COVID-19 participants). Nine out of 50 (18%) COVID-19 participants and 4/46 non-COVID-19 participants (9%) had ³3 persistent symptoms at ³12 months (p=0.174). Among COVID-19 participants, the most common symptoms at ³12 months were fatigue in 4/50 (8%), and headache, loss of appetite, abdominal pain, and heart rate variability (3/50, 6% each). Among non-COVID-19 participants, the most common persistent symptoms were abdominal pain and poor appetite (3/46, 7% each) (Figure 1). For emotional and behavioral items, 16/50 (32%) COVID-19 participants reported being worse or much worse after admission than before compared with 16/46 (35%) non-COVID-19 participants (p=0.941). Both groups rated similarly before and after admission on all the specific items related to emotional welfare, social relationships, and current activities (Supplementary Figures 1 and 2). Among 11/50 (22%) COVID-19 participants, there were 14 new diagnoses including neurological (n=3, 6%), gastrointestinal (n=3, 6%), pulmonary (n=2, 4%) and hematological, osteo-muscular, renal, cardiological, allergy and psychiatric conditions (n=1, 2% each). Among 10/46 (21%) non-COVID-19 participants, there were 10 new diagnoses (one per each participant): gastrointestinal (n=5,11%), skin (n=2, 4%), osteo-muscular, diabetes and neurological conditions (n=1, 2% each). Persistent symptoms 12 months after admission was associated with a new diagnosis (OR 5.16 [95% CI: 1.75; 15.6]. Detailed information on specific diagnoses can be found in Supplementary Table 4. Readmissions occurred in 11/50 (22%) COVID-19 participants and in 6/46 (13%) non-COVID-19 participants (p=0.267). 22/50 (44%) participants with COVID-19 were re infected with COVID-19 during the follow-up. To assess the role of reinfection in persistent symptoms, we compared the prevalence of persistent symptoms and persistent symptoms 1 year after admission in children with reinfection (4/22 [18%] and 2/22 [9%]) compared to children without re infection (13/28 [46%] and 12/28 [43%]). Children without re infection were less likely to have persistent symptoms (OR 0.27, [95% CI 0.06; 0.96]) or persistent symptoms after 1 year (OR 0.15 [95% CI, 0.02; 0.65]). In multivariable analysis, no association was found between any of the risk factors analyzed and the development of persistent symptoms: sex (OR: 0.77; 95% CI [0.07;8.59]), age (OR: 1.23; 95% CI [1.00;1.70]), neurologic conditions (OR: 22.0; 95% CI [0.64;27]), respiratory diseases (OR: 0.00; 95% CI [-;-]), eczema (OR: 0.00; 95% CI [-;-]), severe disease (OR: 0.00; 95% CI [-;-]). We found a weak negative correlation between the number of emotional symptoms and the number of physical symptoms (R=-0.28; β (95% CI) -0.2262 [-0.3844; -0.0680], p=0.005). Discussion The percentage of CYP with persistent symptoms one year after hospitalization was almost twice as high in those hospitalized for acute COVID-19 compared with those hospitalized for other reasons (28% vs 15%) but did not reach statistical significance (p=0.140). Our findings suggest that persistent symptoms are not unique to COVID-19, but the results should be treated with caution and interpretation may be complex. This non-significant difference in a small sample suggests some uncertainty. A growing body of evidence suggests that PASC is associated with persistence of SARS-CoV-2 RNA and proteins in body tissues and cells, immune activation, or combinations. [8, 9] Other virus, including Epstein-Barr, papillomavirus, measles, enterovirus, herpesvirus, parvovirus, and other persists in humans for prolonged periods, leading to chronic inflammation.[10] It seems that a poorly understood interaction exists between virus and the host that goes beyond the acute infection and may develop chronic fatigue and several other unspecific and debilitating symptoms. [11] On the other hand, persistent, unspecific symptoms as headache, abdominal pain or poor appetite may be related to a previous or new chronic physical or emotional condition associated or not with the acute episode of hospitalization, as well as being consistent with PASC. PASC in adults is typically associated with four clinical phenotypes: chronic fatigue syndrome, respiratory syndrome, chronic pain syndrome and neurosensory syndrome. [12] We found that the most common persistent symptoms in COVID-19 participants were fatigue and headache, whereas the most common persistent symptoms in non-COVID-19 participants were abdominal pain and poor appetite, which are not typical of PASC and may be explained by half of the non-COVID-19 participants being admitted for abdominal surgery or gastrointestinal reasons. Some participants had new diagnoses during the follow-up. Persistent symptoms were associated with new diagnoses, which in some COVID-19 participants were consistent with PASC-associated conditions, as migraine, or anxiety, but it is unclear if COVID-19 had any role in triggering persistent symptoms. CYP with persistent symptoms after hospitalization other than COVID-19 have received little attention in the literature. Persistent symptoms may be common in hospitalized children and vary according to the reason for hospitalization. Further research is needed to ensure that all individuals with post-acute sequelae receive the follow-up care they need. The definition of PASC is highly sensitive but specificity is low. There is currently no gold standard for diagnosing PASC. It is unclear whether the instrument we used to diagnose PASC was optimal, especially given the subjective nature of symptoms, and more comprehensive scales may prove valuable in identifying differences in symptoms intensity. [13] In addition, 35% of the study population were <5 years of age and may have difficulty articulating their symptoms. We were unable to demonstrate that persistent symptoms are more common in CYP hospitalized for COVID-19 than in those hospitalized for other reasons. This finding is consistent with the initial findings of the CLOCK study. In this large national study, the occurrence of any symptoms in adolescents (³11 years) who tested positive for SARS-CoV-2 was similar to that of their counterparts who tested negative at baseline after three months of follow-up. [14] However, additional findings suggested that ambulatory CYP with COVID-19 had more persistent symptoms than non-COVID-19 participants. [15] The focus in our study was on hospitalized CYP of all ages, whereas in pediatrics most COVID-19 participants of PASC occur in adolescents after mild disease. Our study has several limitations. The study may have been underpowered with such a small sample size. Also, the sample was small for a model with so many variables, but we believe that excluding key variables might omit essential adjustments for known confounders, potentially biasing our results. Thus, we consider this approach to balance better the risk of omitting important variables against the risk of overfitting. The choice of non-COVID-19 participants may have influenced the persistent symptoms. Some of the non-COVID-19 participants may also have had undiagnosed COVID-19 during follow-up. However, almost all the entire population already had COVID-19 and suspected mild COVID-19 participants are not tested which poses a challenge for conducting studies with larger sample sizes. There is a possible selection bias as the group without record of COVID-19 may not be fully representative of the population that we would like to generalize the results, as most people has been already infected at least once. However, the findings are useful for new generations of children exposed to COVID-19 for the first time. The symptoms reported in the COVID-19 group could have been maintained due to a re infection, but interestingly, children with reinfection had lower odds of persistent symptoms. We did not sample the participants along the follow up, so there are no biological correlates as persistent DNA or proteins associated with symptoms. Conclusions The prevalence of persistent symptoms one year after hospitalization was not significantly different between hospitalized CYP with COVID-19 and non-COVID-19 participants hospitalized for other conditions. Abbreviations Coronavirus disease (COVID-19) Post-acute sequelae of COVID-19 (PASC) Odds ratio (OR) Children and young people (CYP) Declarations Authors’ contributions AT and CM conceptualised and designed the study. IG and SRD performed the statistical analysis. AT, IG, drafted the manuscript. All co-authors participated in the collection of data. All co-authors participated and were involved in the critical review of the final manuscript. Ethics approval: The study was conducted according to the Declaration of Helsinki and subsequent revisions, and it was approved by the Ethics Committee of Hospital 12 de Octubre, Madrid (code 20/101), and other participating hospitals. Consent to participate Participants were enrolled after signed or verbal consent from parents/guardians and by the consent of patients older than 12 years. Consent for publication : Not applicable. Conflict of interest: The authors declare no competing interests. Funding: This work is supported by ORCHESTRA, a three-year international research project aimed at tackling the coronavirus pandemic, funded by the European Union's Horizon 2020 research and innovation program (H2020-RIA GA No.101016167). The views expressed in this document are the sole responsibility of the author and the Commission is not responsible for any use that may be made of the information contained therein. EPICO was supported by Project PI20/00095, from the Instituto de Salud Carlos III (Ministry of Economy, Industry and Competitiveness) and cofounded by the European Regional Development Fund. Acknowledgement: We acknowledge the support of EPICO Consortium and ORCHESTRA Consortium, as well as to the families and participants of this study, and all the staff involved. References Soriano JB, Murthy S, Marshall JC, et al (2022) A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis 22:e102–e107. https://doi.org/10.1016/S1473-3099(21)00703-9 Chiappini E, Pellegrino R, Nascimento-Carvalho CM, Galli L (2023) Recent Insights on Post-COVID in Pediatrics. Pediatric Infectious Disease Journal 42:e304–e307. https://doi.org/10.1097/INF.0000000000003976 Tsampasian V, Elghazaly H, Chattopadhyay R, et al (2023) Risk Factors Associated With Post−COVID-19 Condition: A Systematic Review and Meta-analysis. 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Characteristics of the participants Characteristics Total Non-COVID-19 participants Acute COVID-19 participants p-value N=96 N=46 N=50 Sex Male (n, %) 56/96 (58.3%) 27/46 (58.7%) 29/50 (58.0%) 0.847 Age Years (Median, IQR) 8.25 [1.98-13.7] 6.53 [0.47-13.0] 8.66 [4.35-14.0] 0.711 <2 years (n, %) 23/89 (25.8%) 13/39 (33.3%) 10/50 (20.0%) Ref. 2-5 years (n, %) 9/89 (10.1%) 3/39 (7.69%) 6/50 (12.0%) 0.273 6-11 years (n, %) 24/89 (27.0%) 10/39 (25.6%) 14/50 (28.0%) 0.329 12-18 years (n, %) 33/89 (37.1%) 13/39 (33.3%) 20/50 (40.0%) 0.223 Duration from discharge to interview Years (Median, IQR) 1.89 [1.25-2.07] 1.57 [1.16-2.08] 1.97 [1.39-2.05] 0.864 Length of hospital admission Days (Median, IQR) 4.00 [3.00-6.00] 3.00 [2.00-4.75] 4.00 [3.00-6.00] 0.660 Readmission Yes (n, %) 17/96 (17.7%) 6/46 (13.0%) 11/50 (22.0%) 0.267 Participants with new diagnosis after admission Yes (n, %) 21/96 (21.9%) 10 (21.7%) 11 (22.0%) 0.927 Number of readmissions 1, (n, %) 11/17 (64.7%) 4/6 (66.7%) 7/11 (63.6%) Ref. 2, (n, %) 2/17 (11.8%) 2/6 (33.3%) 0/11 (0.00%) . ≥3, (n, %) 4/17 (23.5%) 0/6 (0.00%) 4/11 (36.4%) . Severe disease (CPAP or IMV or PICU) Yes (n, %) 3/46 (6.52%) 0/0 (0.0 %) 3/46 (6.52%) . Comorbidities Yes (n, %) 44/96 (45.8%) 20/46 (43.5%) 24/50 (48.0%) 0.664 One comorbidity (n, %) 20/96 (20.8%) 10/46 (21.7%) 10/50 (20.0%) 1.000 ≥2 comorbidities (n, %) 24/96 (25.0%) 10/46 (21.7%) 14/50 (28.0%) 0.513 Type of comorbidity Neurological conditions (n, %) 10/96 (10.4%) 4/46 (8.70%) 6/50 (12.0%) 0.620 Heart diseases (n, %) 5/96 (5.21%) 1/46 (2.17%) 4/50 (8.00%) 0.243 Haematological conditions (n, %) 2/96 (2.08%) 0/46 (0.00%) 2/50 (4.00%) . Tuberculosis (n, %) 0/96 (0.0 %) 0/46 (0.0 %) 0/50 (0.0 %) . Respiratory diseases (not asthma) (n, %) 4/67 (5.97%) 2/30 (6.67%) 2/37 (5.41%) 0.841 Food Allergy (n, %) 6/96 (6.25%) 4/46 (8.70%) 2/50 (4.00%) 0.384 Allergic Rhinitis (n, %) 2/96 (2.08%) 1/46 (2.17%) 1/50 (2.00%) 0.958 Eczema (n, %) 12/96 (12.5%) 5/46 (10.9%) 7/50 (14.0%) 0.661 Asthma (n, %) 7/96 (7.29%) 4/46 (8.70%) 3/50 (6.00%) 0.638 Skin problems (not eczema) (n, %) 0/96 (0.00%) 0/46 (0.00%) 0/50 (0.00%) . Gastrointestinal problems (n, %) 8/96 (8.33%) 5/46 (10.9%) 3/50 (6.00%) 0.420 Oncological conditions (n, %) 0/96 (0.00%) 0/46 (0.00%) 0/50 (0.00%) . Immune system diseases (n, %) 3/96 (3.12%) 0/46 (0.0%) 3/50 (6.00%) . Genetic conditions (n, %) 5/96 (5.21%) 0/46 (0.00%) 5/50 (10.0%) . Diabetes mellitus (n, %) 1/96 (1.04%) 1/46 (2.17%) 0/50 (0.00%) . Other endocrine illness (n, %) 3/96 (3.12%) 1/46 (2.17%) 2/50 (4.00%) 0.669 Renal problems (n, %) 2/96 (2.08%) 1/46 (2.17%) 1/50 (2.00%) 0.958 Excessive weight and obesity (n, %) 5/96 (5.21%) 1/46 (2.17%) 4/50 (8.00%) 0.243 Undernutrition (n, %) 1/96 (1.04%) 1/46 (2.17%) 0/50 (0.00%) . Rheumatological conditions (n, %) 0/96 (0.00%) 0/46 (0.00%) 0/50 (0.00%) . Depression (n, %) 0/96 (0.00%) 0/46 (0.00%) 0/50 (0.00%) . Anxiety (n, %) 1/96 (1.04%) 0/46 (0.00%) 1/50 (2.00%) . HIV (n, %) 0/96 (0.00%) 0/46 (0.00%) 0/50 (0.00%) . Persistent symptoms dichotomic Yes (n, %) 34/96 (35.4%) 17/46 (37.0%) 17/50 (34.0%) 0.767 Persistent symptoms 0 (n, %) 62/96 (64.6%) 29/46 (63.0%) 33/50 (66.0%) Ref. 1 (n, %) 10/96 (10.4%) 9/46 (19.6%) 1/50 (2.00%) 0.012 2 (n, %) 6/96 (6.25%) 2/46 (4.35%) 4/50 (8.00%) 0.570 ≥3 (n, %) 18/96 (18.8%) 6/46 (13.0%) 12/50 (24.0%) 0.329 ≥3 persistent symptoms dichotomic Yes (n, %) 18/96 (18.8%) 6/46 (13.0%) 12/50 (24.0%) 0.182 Persistent symptoms dichotomic ≥12 months Yes (n, %) 21/96 (21.9%) 7/46 (15.2%) 14/50 (28.0%) 0.140 Persistent symptoms ≥12 months 0 (n, %) 75/96 (78.1%) 39/46 (84.8%) 36/50 (72.0%) Ref. 1 (n, %) 3/96 (3.12%) 2/46 (4.35%) 1/50 (2.00%) 0.679 2 (n, %) 5/96 (5.21%) 1/46 (2.17%) 4/50 (8.00%) 0.207 ≥3 (n, %) 13/96 (13.5%) 4/46 (8.70%) 9/50 (18.0%) 0.174 Worse mood and behaviour Yes (n, %) 32/93 (34.4%) 16/46 (34.8%) 16/47 (34.0%) 0.941 COVID-19 vaccination Yes (n, %) 41/96 (42.7%) 21/46 (45.7%) 20/50 (40.0%) 0.584 Before admission (n, %) 0 (. %) 0 (. %) 0 (. %) . After admission (n, %) 30/30 (100%) 15/15 (100%) 15/15 (100%) . IQR: interquartile range; NA: Not applicable; CPAP: Continuous positive airway pressure; IMV: Invasive Mechanical Ventilation; PICU: Pediatric Intensive Care Unit admission. Additional Declarations No competing interests reported. Supplementary Files SUPPLEMENTARYMATERIAL.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4582926","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":327172543,"identity":"f27594ba-4504-4713-aba4-97dad4f82ac3","order_by":0,"name":"Alfredo Tagarro","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYDACdsYHDAxscK4NEDM2HsCrhZnZAKRFAspNA2lpIEnLYTCJVwt/MzPbhw9lNnX8/Yuffa6oOG+3tv0w0JYam2hcWiQOMzPPnHEuTULixjPjmWfO3E7ediYRqOVYWm4DLj2H+Q8z87YdlmC4ccCYsbHtdrLZAaAWxobDOLXIA21h/gvUIn/j+GeglnPJZucf4tdiANLCCNRicL4HZMsBO7MbBGwxBGph7DmXJrnxBk8xY8OZ5ASzG0BbEvD4Re54MzPDjzIbfrnzxzczNlTY2ZudT3/44EONDW7vw4FEAphKBKtMIKgcBPgPgCl7ohSPglEwCkbBiAIANMdh5s0Q/9EAAAAASUVORK5CYII=","orcid":"","institution":"Instituto de Investigación 12 de Octubre (imas12). 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Fundación para la Investigación Hospital 12 de Octubre, Madrid, Spain.","correspondingAuthor":false,"prefix":"","firstName":"Irati","middleName":"","lastName":"Gastesi","suffix":""},{"id":327172547,"identity":"02826dd5-4db6-4d83-a69f-831e5bc9b983","order_by":3,"name":"Lucía de Pablo","email":"","orcid":"","institution":"Fundación para la Investigación Biomédica e Innovación Hospital, Universitario Infanta Sofía y del Henares (FIIB HUIS HHEN), Hospital Universitario Infanta Sofía","correspondingAuthor":false,"prefix":"","firstName":"Lucía","middleName":"","lastName":"de Pablo","suffix":""},{"id":327172550,"identity":"82950a2a-70f9-4f92-bd8d-62f289b1deb0","order_by":4,"name":"Sara Villanueva","email":"","orcid":"","institution":"Instituto de Investigación 12 de Octubre (imas12). 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RITIP., Pediatric Infectious Diseases, Madrid, Spain.","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Aguilera-Alonso","suffix":""},{"id":327172552,"identity":"41f12163-bf8e-4a6a-8c1c-2b79d523e3df","order_by":6,"name":"Ana Esteban","email":"","orcid":"","institution":"Fundación para la Investigación Biomédica e Innovación Hospital, Universitario Infanta Sofía y del Henares (FIIB HUIS HHEN), Hospital Universitario Infanta Sofía","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"","lastName":"Esteban","suffix":""},{"id":327172553,"identity":"05ef14dc-01c1-4fa2-86fd-69478c874f5c","order_by":7,"name":"Cristina Epalza","email":"","orcid":"","institution":"Hospital Universitario 12 de Octubre","correspondingAuthor":false,"prefix":"","firstName":"Cristina","middleName":"","lastName":"Epalza","suffix":""},{"id":327172554,"identity":"f82d16ae-b2d4-47e3-9fdc-912af2f61ae1","order_by":8,"name":"María López","email":"","orcid":"","institution":"Fundación para la Investigación Biomédica e Innovación Hospital, Universitario Infanta Sofía y del Henares (FIIB HUIS HHEN), Hospital Universitario Infanta Sofía","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"","lastName":"López","suffix":""},{"id":327172555,"identity":"44d11cf9-7374-49a7-8972-ad10c1fb4213","order_by":9,"name":"Sara Domínguez-Rodríguez","email":"","orcid":"","institution":"Instituto de Investigación 12 de Octubre (imas12). 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Fundación para la Investigación Hospital 12 de Octubre, Madrid, Spain.","correspondingAuthor":false,"prefix":"","firstName":"Álvaro","middleName":"","lastName":"Ballesteros","suffix":""},{"id":327172558,"identity":"d506cfd2-abff-4779-8c94-ced682fca21b","order_by":12,"name":"Carlota Pinto","email":"","orcid":"","institution":"European University of Madrid","correspondingAuthor":false,"prefix":"","firstName":"Carlota","middleName":"","lastName":"Pinto","suffix":""},{"id":327172559,"identity":"1c657323-1cd6-4e27-9869-e1bfc3be868f","order_by":13,"name":"Marisa Navarro","email":"","orcid":"","institution":"Instituto de Investigación Sanitaria Gregorio Marañón (lisGM). CIBERINFEC. RITIP., Pediatric Infectious Diseases, Madrid, Spain.","correspondingAuthor":false,"prefix":"","firstName":"Marisa","middleName":"","lastName":"Navarro","suffix":""},{"id":327172560,"identity":"5a12e864-dc5d-4fc4-b316-1c8f981afc85","order_by":14,"name":"Carlo Giaquinto","email":"","orcid":"","institution":"PENTA Foundation","correspondingAuthor":false,"prefix":"","firstName":"Carlo","middleName":"","lastName":"Giaquinto","suffix":""},{"id":327172561,"identity":"6a0ca8a8-3b3f-4637-8336-5fd5d98c8b13","order_by":15,"name":"Cinta Moraleda","email":"","orcid":"","institution":"Instituto de Investigación 12 de Octubre (imas12). Fundación para la Investigación Hospital 12 de Octubre, Madrid, Spain.","correspondingAuthor":false,"prefix":"","firstName":"Cinta","middleName":"","lastName":"Moraleda","suffix":""}],"badges":[],"createdAt":"2024-06-14 15:10:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4582926/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4582926/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60621686,"identity":"fc5b23e5-62dc-4811-87a3-c2989f955ee4","added_by":"auto","created_at":"2024-07-18 21:03:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":260754,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSymptoms 1 year after admission due to acute COVID-19 participants and other conditions. None of the comparisons between participants with and without COVID-19 reached statistical significance p\u0026lt;0.05.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4582926/v1/081eb17ee3d8ca281b09fcb5.png"},{"id":63807991,"identity":"c679c243-92bc-4716-85d8-014f582d7a94","added_by":"auto","created_at":"2024-09-02 13:46:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1002996,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4582926/v1/9f17b278-2ae9-450c-99c9-46f1f25a11f4.pdf"},{"id":60621687,"identity":"0d68d1a1-ad9f-4939-8508-b07b4782acc0","added_by":"auto","created_at":"2024-07-18 21:03:07","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":148520,"visible":true,"origin":"","legend":"","description":"","filename":"SUPPLEMENTARYMATERIAL.docx","url":"https://assets-eu.researchsquare.com/files/rs-4582926/v1/a666bcf717690a3afe854af0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Persistent symptoms after 1 year in hospitalized children with acute COVID-19 compared to other conditions","fulltext":[{"header":"What is known?","content":"\u003cul\u003e\n \u003cli\u003eNumerous COVID-19 patients experience enduring physical, cognitive, and mental health issues lasting over three months post-infection, referred to as long COVID or post-COVID-19 condition.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWhat is knew?\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe prevalence of persistent symptoms one year after hospitalization was high, but not significantly different between hospitalized CYP with COVID-19 and non-COVID-19 participants hospitalized for other conditions.\u003c/li\u003e\n \u003cli\u003ePersistent symptoms may be common in hospitalized children and vary according to the reason for hospitalization.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eMuch attention has been focused on the persistent symptoms following coronavirus disease (COVID-19), termed post-acute sequelae of COVID-19 (PASC), long COVID, or post-COVID condition. The prevalence in the pediatric population ranges from 1.7% to 70%.[1, 2] Previous hospitalization has been associated in adults with an increased risk of PASC (odds ratio [OR], 2.48; 95%CI, 1.97 ; 3.13). [3] Our understanding of this condition is hampered by the paucity of case\u0026ndash;control studies, particularly in the pediatric population. We evaluated the prevalence and characteristics of persistent signs and/or symptoms in children and young people (CYP) one year after hospitalization for acute COVID-19 compared with a control group of CYP hospitalized for other conditions, assessing whether COVID-19, and associated interventions, confers any additional risk of persistent symptoms beyond any risk conferred by being hospitalised and the interventions received there.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe conducted an observational study in three hospitals in Madrid, Spain (Hospital Universitario 12 de Octubre (HU12O), Hospital Universitario Gregorio Mara\u0026ntilde;\u0026oacute;n (HUGM), and Hospital Universitario Infanta Sof\u0026iacute;a (HUIS),\u0026nbsp;nested in a prospective, observational cohort\u0026ndash;\u0026ndash;the Epidemiological Study of COVID-19 (EPICO). We included a group of children who aged 1 month to 18 years of age who were hospitalized for acute COVID-19 from March 2020 to December 2021 and included in the EPICO cohort. Patients with multisystem inflammatory syndrome in children were excluded. We selected a group of patients for comparison among hospitalized patients at HUIS and HU12O the same month as the participants with COVID-19, for different reasons, including acute medical and surgery-related reasons, who tested negative for COVID-19 at admission, and with no reported or recorded history of COVID-19 at recruitment or during follow-up. COVID-19 group, and comparison group patients were matched 1:1 by month of admission, sex, and age group (\u0026lt;5, 5 to 10 and \u003cu\u003e\u0026gt;\u003c/u\u003e10 years). The causes of admission of the comparison group are shown in Supplementary Table S1. Two components were carried out for this study. Firstly, a questionnaire was adapted from the ISARIC questionnaire (available on request).\u0026nbsp;[4]\u0026nbsp;Data were collected from clinical records on participants\u0026rsquo; initial hospitalization, new diagnoses after hospitalization, time of diagnosis and current situation, and readmission. Secondly, families were contacted by telephone, and a standardized questionnaire was administered from March 2022 to November 2022, at least one year after the admission of each participant. The questionnaire could be answered online by the caregiver or by telephone interview with research staff. CYP could participate in completing the form at the discretion of the caregiver. The questionnaire included sections on emotional welfare, social relationships, and activities compared before and after admission, and a section related to current and past physical health. All data were collected using REDCap electronic data collection tools.\u0026nbsp;[5]\u0026nbsp;A specific informed consent was prepared for non-COVID-19 patients, participants with COVID-19 provided consent at enrolment.\u0026nbsp;The study was approved by the relevant Ethics Committee (code 20/101).\u003c/p\u003e\n\u003cp\u003ePersistent symptoms were defined as the development or continuation of new symptoms three months after the initial infection, with these symptoms lasting for at least two months without explanation.\u0026nbsp;[6]\u0026nbsp;The primary outcome was the presence of persistent symptoms one year after hospitalization. The secondary outcome was parental perception of mood and behavioral changes in CYP.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extracted baseline socio-demographic and clinical characteristics to describe the study population, and data are presented for all participants and summarized by group. Continuous variables were tested for normality using the Shapiro-Wilk test and were reported as mean and standard deviation (SD) when normally distributed and as median and interquartile range (IQR) if non-normally distributed. Categorical variables were summarized as frequency counts and percentages. The denominator for each percentage was the number of subjects within the population group without excluding missing observations, unless otherwise stated. Chi-squared test and Fisher\u0026rsquo;s test were used to test for differences between groups, as appropriate. Student\u0026rsquo;s t-test was used for normally distributed continuous variables, and non-parametric tests (Mann-Whitney U test or Kruskal-Wallis) were used for non-normally distributed data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll hypothesis tests were performed at the 5% significance level, and p-values were rounded to three decimal places. In summary tables, p-values less than 0.001 are reported as \u0026lt;0.001 as implemented in the compare Groups R package.\u0026nbsp;[7].\u003c/p\u003e\n\u003cp\u003eA linear regression analysis and Pearson correlation test were employed to evaluate the strength and direction of the association between physical symptoms (independent variable) and emotional symptoms (dependent variable), quantifying the linear dependency between these two variables. A multivariate logistic model was developed to assess the risk factors associated with the development of persistent symptoms. The model included demographic characteristics (sex at birth and age) and comorbidities (neurological conditions, gastrointestinal problems, heart diseases, respiratory diseases, asthma, eczema, food allergies, other endocrine illnesses, renal problems, excessive weight, and obesity), as well as variables for admission time, severe disease and COVID-19 vaccination. The results were summarized using ORs with 95% confidence intervals. Variables were selected according to the Akaike Information Criterion (AIC) using the forward selection method.\u003c/p\u003e\n\u003cp\u003eTo avoid loss of information and statistical power in the association analysis, missing data will be imputed using a non-parametric random forest imputation algorithm. To prevent too many assumptions, only variables with less than 20% of missing information will be considered for imputation the other variables will be treated as complete cases without considering missing information. Missing observations were balanced between both groups.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eNinety-six patients were enrolled and analyzed (50 acute COVID-19 patients and 46 non-COVID-19 participants) after excluding four patients due to incomplete data. Fifty-seven\u0026nbsp;patients (58.3%) were male at birth. No differences were found in baseline characteristics between COVID-19 participants and non-COVID-19 participants (Table 1).\u003c/p\u003e\n\u003cp\u003eFamilies were interviewed at a median of 1.89 years (IQR, 1.25-2.07) after hospitalization. The definition of persistent symptoms was met in 34/96 (35%) CYP: 17/50 (34%) COVID-19 participants and\u0026nbsp;17/46 (37%) non-COVID-19 participants (p=0.767).\u0026nbsp;Symptoms persisted\u0026nbsp;\u0026sup3;12 months in 14/50 (28%) COVID-19 participants and in\u0026nbsp;7/46 (15%) non-COVID-19 participants (p=0.140).\u003c/p\u003e\n\u003cp\u003eNon-COVID-19 participants were more likely to present with only one persistent symptom (9/46, 20% vs. 1/50, 2% of COVID-19 participants), but the difference decreased\u0026nbsp;\u0026sup3;12 months after hospitalization (2/46, [4%] vs 1/50, [2%] of COVID-19 participants). Nine out of 50 (18%) COVID-19 participants and 4/46 non-COVID-19 participants (9%) had\u0026nbsp;\u0026sup3;3 persistent symptoms at\u0026nbsp;\u0026sup3;12 months (p=0.174).\u003c/p\u003e\n\u003cp\u003eAmong COVID-19 participants, the most common symptoms at\u0026nbsp;\u0026sup3;12 months were fatigue in 4/50 (8%), and headache, loss of appetite, abdominal pain, and heart rate variability (3/50, 6% each). Among non-COVID-19 participants, the most common persistent symptoms were abdominal pain and poor appetite (3/46, 7% each) (Figure 1).\u003c/p\u003e\n\u003cp\u003eFor emotional\u0026nbsp;and behavioral items, 16/50 (32%) COVID-19 participants reported being worse or much worse after admission than before compared with 16/46 (35%) non-COVID-19 participants (p=0.941). Both groups rated similarly before and after admission on all the specific items related to emotional welfare, social relationships, and current activities (Supplementary Figures 1 and 2).\u003c/p\u003e\n\u003cp\u003eAmong 11/50 (22%) COVID-19 participants, there were 14 new diagnoses including neurological (n=3, 6%), gastrointestinal (n=3, 6%), pulmonary (n=2, 4%) and hematological, osteo-muscular, renal, cardiological, allergy and psychiatric conditions (n=1, 2% each). Among 10/46 (21%) non-COVID-19 participants, there were 10 new diagnoses (one per each participant): gastrointestinal (n=5,11%), skin (n=2, 4%), osteo-muscular, diabetes and neurological conditions (n=1, 2% each). Persistent symptoms 12 months after admission was associated with a new diagnosis (OR 5.16 [95% CI: 1.75; 15.6]. Detailed information on specific diagnoses can be found in Supplementary Table 4.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReadmissions occurred in 11/50 (22%) COVID-19 participants and in 6/46 (13%) non-COVID-19 participants (p=0.267).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e22/50 (44%) participants with COVID-19 were re infected with COVID-19 during the follow-up. To assess the role of reinfection in persistent symptoms, we compared the prevalence of persistent symptoms and persistent symptoms 1 year after admission in children with reinfection (4/22 [18%] and 2/22 [9%]) compared to children without re infection (13/28 [46%] and 12/28 [43%]). Children without re infection were less likely to have persistent symptoms (OR 0.27, [95% CI 0.06; 0.96]) or persistent symptoms after 1 year (OR 0.15 [95% CI, 0.02; 0.65]).\u003c/p\u003e\n\u003cp\u003eIn multivariable analysis, no association was found between any of the risk factors analyzed and the development of persistent symptoms: sex (OR: 0.77; 95% CI [0.07;8.59]), age (OR: 1.23; 95% CI [1.00;1.70]), neurologic conditions (OR: 22.0; 95% CI [0.64;27]), respiratory diseases (OR: 0.00; 95% CI [-;-]), eczema (OR: 0.00; 95% CI [-;-]), severe disease (OR: 0.00; 95% CI [-;-]). \u003cs\u003e\u0026nbsp;\u003c/s\u003e\u003c/p\u003e\n\u003cp\u003eWe found a weak negative correlation between the number of emotional symptoms and the number of physical symptoms (R=-0.28; \u0026beta; (95% CI) -0.2262 [-0.3844; -0.0680], p=0.005).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe percentage of CYP with persistent symptoms one year after hospitalization was almost twice as high in those hospitalized for acute COVID-19 compared with those hospitalized for other reasons (28% vs 15%) but did not reach statistical significance (p=0.140).\u0026nbsp;Our findings suggest that persistent symptoms are not unique to COVID-19, but the results should be treated with caution and interpretation may be complex. This non-significant difference in a small sample suggests some uncertainty. A growing body of evidence suggests that PASC is associated with persistence of SARS-CoV-2 RNA and proteins in body tissues and cells, immune activation, or combinations.\u0026nbsp;[8, 9]\u0026nbsp;Other virus, including Epstein-Barr, papillomavirus, measles, enterovirus, herpesvirus, parvovirus, and other persists in humans for prolonged periods, leading to chronic inflammation.[10]\u0026nbsp;It seems that a poorly understood interaction exists between virus and the host that goes beyond the acute infection and may develop chronic fatigue and several other unspecific and debilitating symptoms.\u0026nbsp;[11]\u0026nbsp;On the other hand, persistent, unspecific symptoms as headache, abdominal pain or poor appetite may be related to a previous or new chronic physical or emotional condition associated or not with the acute episode of hospitalization, as well as being consistent with PASC.\u003c/p\u003e\n\u003cp\u003ePASC in adults is typically associated with four clinical phenotypes: chronic fatigue syndrome, respiratory syndrome, chronic pain syndrome and neurosensory syndrome.\u0026nbsp;[12]\u0026nbsp;We found that the most common persistent symptoms in COVID-19 participants were fatigue and headache, whereas the most common persistent symptoms in non-COVID-19 participants were abdominal pain and poor appetite, which are not typical of PASC and may be explained by half of the non-COVID-19 participants being admitted for abdominal surgery or gastrointestinal reasons.\u0026nbsp;Some participants had new diagnoses during the follow-up. Persistent symptoms were associated with new diagnoses, which in some COVID-19 participants were consistent with PASC-associated conditions, as migraine, or anxiety, but it is unclear if COVID-19 had any role in triggering persistent symptoms.\u003c/p\u003e\n\u003cp\u003eCYP with persistent symptoms after hospitalization other than COVID-19 have received little attention in the literature. Persistent symptoms may be common in hospitalized children and vary according to the reason for hospitalization. Further research is needed to ensure that all individuals with post-acute sequelae receive the follow-up care they need.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe definition of PASC is highly sensitive but specificity is low. There is currently no gold standard for diagnosing PASC. It is unclear whether the instrument we used to diagnose PASC was optimal, especially given the subjective nature of symptoms, and more comprehensive scales may prove valuable in identifying differences in symptoms intensity.\u0026nbsp;[13]\u0026nbsp;In addition, 35% of the study population were \u0026lt;5 years of age and may have difficulty articulating their symptoms.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe were unable to demonstrate that persistent symptoms are more common in CYP hospitalized for COVID-19 than in those hospitalized for other reasons. This finding is consistent with the initial findings of the CLOCK study. In this large national study, the occurrence of any symptoms in adolescents (\u0026sup3;11 years) who tested positive for SARS-CoV-2 was similar to that of their counterparts who tested negative at baseline after three months of follow-up.\u0026nbsp;[14]\u0026nbsp;However, additional findings suggested that ambulatory CYP with COVID-19 had more persistent symptoms than non-COVID-19 participants.\u0026nbsp;[15]\u0026nbsp;The focus in our study was on hospitalized CYP of all ages, whereas in pediatrics most COVID-19 participants of PASC occur in adolescents after mild disease.\u003c/p\u003e\n\u003cp\u003eOur study has several limitations.\u0026nbsp;The study\u0026nbsp;may have been\u0026nbsp;underpowered with such a small sample size.\u0026nbsp;Also, the sample was small for a model with so many variables, but we believe that excluding key variables might omit essential adjustments for known confounders, potentially biasing our results. Thus, we consider this approach to balance better the risk of omitting important variables against the risk of overfitting. The choice of non-COVID-19 participants may have influenced the persistent symptoms. Some of the non-COVID-19 participants may also have had undiagnosed COVID-19 during follow-up. However, almost all the entire population already had COVID-19 and suspected mild COVID-19 participants are not tested which poses a challenge for conducting studies with larger sample sizes. There is a possible selection bias as the group without record of COVID-19 may not be fully representative of the population that we would like to generalize the results, as most people has been already infected at least once. However, the findings are useful for new generations of children exposed to COVID-19 for the first time.\u003c/p\u003e\n\u003cp\u003eThe symptoms reported in the COVID-19 group could have been maintained due to a re infection, but interestingly, children with reinfection had lower odds of persistent symptoms. We did not sample the participants along the follow up, so there are no biological correlates as persistent DNA or proteins associated with symptoms.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions ","content":"\u003cp\u003eThe prevalence of persistent symptoms one year after hospitalization was not significantly different between hospitalized CYP with COVID-19 and non-COVID-19 participants hospitalized for other conditions.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCoronavirus disease (COVID-19)\u003c/p\u003e\n\u003cp\u003ePost-acute sequelae of COVID-19 (PASC)\u003c/p\u003e\n\u003cp\u003eOdds ratio (OR)\u003c/p\u003e\n\u003cp\u003eChildren and young people (CYP)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAT and CM conceptualised and designed the study. IG and SRD performed the statistical analysis. AT, IG, drafted the manuscript. All co-authors participated in the collection of data. All co-authors participated and were involved in the critical review of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e The study was conducted according to the Declaration of Helsinki and subsequent revisions, and it was approved by the Ethics Committee of Hospital 12 de Octubre, Madrid (code 20/101), and other participating hospitals.\u003c/p\u003e\n\u003cp\u003eConsent to participate Participants were enrolled after signed or verbal consent from parents/guardians and by the consent of patients older than 12 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work is supported by ORCHESTRA, a three-year international research project aimed at tackling the coronavirus pandemic, funded by the European Union\u0026apos;s Horizon 2020 research and innovation program (H2020-RIA GA No.101016167). The views expressed in this document are the sole responsibility of the author and the Commission is not responsible for any use that may be made of the information contained therein.\u003c/p\u003e\n\u003cp\u003eEPICO was supported by Project PI20/00095, from the Instituto de Salud Carlos III (Ministry of Economy, Industry and Competitiveness) and cofounded by the European Regional Development Fund.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the support of EPICO Consortium and ORCHESTRA Consortium, as well as to the families and participants of this study, and all the staff involved.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSoriano JB, Murthy S, Marshall JC, et al (2022) A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis 22:e102\u0026ndash;e107. https://doi.org/10.1016/S1473-3099(21)00703-9\u003c/li\u003e\n\u003cli\u003eChiappini E, Pellegrino R, Nascimento-Carvalho CM, Galli L (2023) Recent Insights on Post-COVID in Pediatrics. Pediatric Infectious Disease Journal 42:e304\u0026ndash;e307. https://doi.org/10.1097/INF.0000000000003976\u003c/li\u003e\n\u003cli\u003eTsampasian V, Elghazaly H, Chattopadhyay R, et al (2023) Risk Factors Associated With Post\u0026minus;COVID-19 Condition: A Systematic Review and Meta-analysis. JAMA Intern Med 183:566. https://doi.org/10.1001/jamainternmed.2023.0750\u003c/li\u003e\n\u003cli\u003eOsmanov IM, Spiridonova E, Bobkova P, et al (2022) Risk factors for post-COVID-19 condition in previously hospitalised children using the ISARIC Global follow-up protocol: a prospective cohort study. Eur Respir J 59:2101341. https://doi.org/10.1183/13993003.01341-2021\u003c/li\u003e\n\u003cli\u003eHarris PA, Taylor R, Minor BL, et al (2019) The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics 95:103208. https://doi.org/10.1016/j.jbi.2019.103208\u003c/li\u003e\n\u003cli\u003eWorld Health Organization A clinical case definition of post COVID-19 condition by a Delphi consensus. WHO 2021. WHO reference number: WHO/2019-nCoV/Post_COVID-19_condition/Clinical_case_definition/2021.1.Last accesed, November 6th 2021.\u003c/li\u003e\n\u003cli\u003eSubirana I, Vila J, Sanz H, Gavin L, Penafiel J, Gimenez D. Package compareGroups. 2018. Available: https://cran.r-project.org/web/packages/compareGroups/index.html\u003c/li\u003e\n\u003cli\u003eProal AD, VanElzakker MB, Aleman S, et al (2023) SARS-CoV-2 reservoir in post-acute sequelae of COVID-19 (PASC). Nat Immunol 24:1616\u0026ndash;1627. https://doi.org/10.1038/s41590-023-01601-2\u003c/li\u003e\n\u003cli\u003eSherif ZA, Gomez CR, Connors TJ, et al (2023) Pathogenic mechanisms of post-acute sequelae of SARS-CoV-2 infection (PASC). eLife 12:e86002. https://doi.org/10.7554/eLife.86002\u003c/li\u003e\n\u003cli\u003ePy\u0026ouml;ri\u0026auml; L, Pratas D, Toppinen M, et al (2023) Unmasking the tissue-resident eukaryotic DNA virome in humans. Nucleic Acids Research 51:3223\u0026ndash;3239. https://doi.org/10.1093/nar/gkad199\u003c/li\u003e\n\u003cli\u003eBuonsenso D, Tantisira KG (2024) Long COVID and SARS-CoV-2 persistence: new answers, more questions. The Lancet Infectious Diseases S1473309924002160. https://doi.org/10.1016/S1473-3099(24)00216-0\u003c/li\u003e\n\u003cli\u003eGentilotti E, G\u0026oacute;rska A, Tami A, et al (2023) Clinical phenotypes and quality of life to define post-COVID-19 syndrome: a cluster analysis of the multinational, prospective ORCHESTRA cohort. eClinicalMedicine 62:102107. https://doi.org/10.1016/j.eclinm.2023.102107\u003c/li\u003e\n\u003cli\u003eBecerra-Garc\u0026iacute;a JA, S\u0026aacute;nchez-Guti\u0026eacute;rrez T (2023) Long-COVID psychological symptoms in child and adolescent population: A standardized proposal for its exploration. Enferm Infecc Microbiol Clin (Engl Ed) 41:384\u0026ndash;385. https://doi.org/10.1016/j.eimce.2023.04.010\u003c/li\u003e\n\u003cli\u003eStephenson T, Pinto Pereira SM, Shafran R, et al (2022) Physical and mental health 3 months after SARS-CoV-2 infection (long COVID) among adolescents in England (CLoCk): a national matched cohort study. The Lancet Child \u0026amp; Adolescent Health 6:230\u0026ndash;239. https://doi.org/10.1016/S2352-4642(22)00022-0\u003c/li\u003e\n\u003cli\u003ePinto Pereira SM, Mensah A, Nugawela MD, et al (2023) Long COVID in Children and Young after Infection or Reinfection with the Omicron Variant: A Prospective Observational Study. The Journal of Pediatrics 259:113463. https://doi.org/10.1016/j.jpeds.2023.113463\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Characteristics of the participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"707\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-COVID-19 participants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcute COVID-19 participants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=96\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=46\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=50\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eMale (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e56/96 (58.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e27/46 (58.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e29/50 (58.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.847\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eYears (Median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e8.25 [1.98-13.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e6.53 [0.47-13.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e8.66 [4.35-14.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.711\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026lt;2 years (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e23/89 (25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e13/39 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e10/50 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;2-5 years (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e9/89 (10.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e3/39 (7.69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e6/50 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;6-11 years (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e24/89 (27.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e10/39 (25.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e14/50 (28.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.329\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;12-18 years (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e33/89 (37.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e13/39 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e20/50 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration from discharge to interview\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eYears (Median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e1.89 [1.25-2.07]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e1.57 [1.16-2.08]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e1.97 [1.39-2.05]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.864\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of hospital admission\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eDays (Median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e4.00 [3.00-6.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e3.00 [2.00-4.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e4.00 [3.00-6.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.660\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReadmission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eYes (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e17/96 (17.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e6/46 (13.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e11/50 (22.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.267\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants with new diagnosis after admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eYes (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e21/96 (21.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e10 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e11 (22.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.927\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of readmissions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e1, (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e11/17 (64.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e4/6 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e7/11 (63.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e2, (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e2/17 (11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e2/6 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e0/11 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;3, (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e4/17 (23.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e0/6 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e4/11 (36.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere disease (CPAP or IMV or PICU)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eYes (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e3/46 (6.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e0/0 (0.0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e3/46 (6.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eYes (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e44/96 (45.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e20/46 (43.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e24/50 (48.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.664\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eOne comorbidity (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e20/96 (20.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e10/46 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e10/50 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;2 comorbidities (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e24/96 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e10/46 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e14/50 (28.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.513\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of comorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eNeurological conditions (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e10/96 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e4/46 (8.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e6/50 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.620\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eHeart diseases (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e5/96 (5.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e1/46 (2.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e4/50 (8.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eHaematological conditions (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e2/96 (2.08%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e0/46 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e2/50 (4.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eTuberculosis (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e0/96 (0.0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e0/46 (0.0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e0/50 (0.0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eRespiratory diseases (not asthma) (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e4/67 (5.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e2/30 (6.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e2/37 (5.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eFood Allergy (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e6/96 (6.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e4/46 (8.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e2/50 (4.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eAllergic Rhinitis (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e2/96 (2.08%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e1/46 (2.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e1/50 (2.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.958\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eEczema (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e12/96 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e5/46 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e7/50 (14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.661\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eAsthma (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e7/96 (7.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e4/46 (8.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e3/50 (6.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.638\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eSkin problems (not eczema) (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e0/96 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e0/46 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e0/50 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eGastrointestinal problems (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e8/96 (8.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e5/46 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e3/50 (6.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.420\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eOncological conditions (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e0/96 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e0/46 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e0/50 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eImmune system diseases (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e3/96 (3.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e0/46 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e3/50 (6.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eGenetic conditions (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e5/96 (5.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e0/46 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e5/50 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes mellitus (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e1/96 (1.04%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e1/46 (2.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e0/50 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eOther endocrine illness (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e3/96 (3.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e1/46 (2.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e2/50 (4.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.669\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eRenal problems (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e2/96 (2.08%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e1/46 (2.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e1/50 (2.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.958\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eExcessive weight and obesity (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e5/96 (5.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e1/46 (2.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e4/50 (8.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eUndernutrition (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e1/96 (1.04%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e1/46 (2.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e0/50 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eRheumatological conditions (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e0/96 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e0/46 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e0/50 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eDepression (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e0/96 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e0/46 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e0/50 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eAnxiety (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e1/96 (1.04%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e0/46 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e1/50 (2.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eHIV (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e0/96 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e0/46 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e0/50 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersistent symptoms dichotomic\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eYes (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e34/96 (35.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e17/46 (37.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e17/50 (34.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.767\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersistent symptoms\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e0 (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e62/96 (64.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e29/46 (63.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e33/50 (66.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e1 (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e10/96 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e9/46 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e1/50 (2.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e2 (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e6/96 (6.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e2/46 (4.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e4/50 (8.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.570\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;3 (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e18/96 (18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e6/46 (13.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e12/50 (24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.329\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;3 persistent symptoms dichotomic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eYes (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e18/96 (18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e6/46 (13.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e12/50 (24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersistent symptoms dichotomic \u0026ge;12 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eYes (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e21/96 (21.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e7/46 (15.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e14/50 (28.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersistent symptoms \u0026ge;12 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e0 (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e75/96 (78.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e39/46 (84.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e36/50 (72.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e1 (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e3/96 (3.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e2/46 (4.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e1/50 (2.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.679\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e2 (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e5/96 (5.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e1/46 (2.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e4/50 (8.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.207\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;3 (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e13/96 (13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e4/46 (8.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e9/50 (18.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorse mood and behaviour\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eYes (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e32/93 (34.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e16/46 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e16/47 (34.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.941\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOVID-19 vaccination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eYes (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e41/96 (42.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e21/46 (45.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e20/50 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e0.584\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eBefore admission (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e0 (. %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e0 (. %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e0 (. %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.097595473833096%\" valign=\"top\"\u003e\n \u003cp\u003eAfter admission (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.983026874115984%\" valign=\"top\"\u003e\n \u003cp\u003e30/30 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.397454031117398%\" valign=\"top\"\u003e\n \u003cp\u003e15/15 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.77227722772277%\" valign=\"top\"\u003e\n \u003cp\u003e15/15 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74964639321075%\" valign=\"top\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIQR: interquartile range; NA: Not applicable; CPAP: Continuous positive airway pressure; IMV: Invasive Mechanical Ventilation; PICU: Pediatric Intensive Care Unit admission.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Post-Acute COVID-19 Syndrome, children, COVID-19, SARS-CoV-2, chronic fatigue disorder","lastPublishedDoi":"10.21203/rs.3.rs-4582926/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4582926/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe evaluated the prevalence and characteristics of persistent signs and/or symptoms in children and young people (CYP) one year after hospitalization for acute COVID-19 compared with a control group of CYP hospitalized for other conditions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted an observational study in three hospitals in Madrid. We included a group of children who aged 1 month to 18 years of age who were hospitalized for acute COVID-19 from March 2020 to December 2021. We selected a group of patients for comparison among hospitalized patients the same month as the participants with COVID-19, for different reasons, with no history of COVID-19 at recruitment or during follow-up. Data were collected from clinical records and a standardized questionnaire answered by families. The primary outcome was the presence of persistent symptoms one year after hospitalization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNinety-six patients were enrolled and analyzed (50 acute COVID-19 patients and 46 non-COVID-19 participants). The definition of persistent symptoms was met in 34/96 (35%) CYP: 17/50 (34%) COVID-19 participants and 17/46 (37%) non-COVID-19 participants (p=0.767). Symptoms persisted ³12 months in 14/50 (28%) COVID-19 participants and in 7/46 (15%) non-COVID-19 participants (p=0.140).\u003c/p\u003e\n\u003cp\u003eBoth groups rated similarly before and after admission on all the specific items related to emotional welfare, social relationships, and current activities. Readmissions occurred in 11/50 (22%) COVID-19 participants and in 6/46 (13%) non-COVID-19 participants (p=0.267).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: This study found a non-significant difference in the prevalence of persistent symptoms 1 year after hospitalization between children and young people (CYP) with acute COVID-19 and those hospitalized for other reasons.\u003c/p\u003e","manuscriptTitle":"Persistent symptoms after 1 year in hospitalized children with acute COVID-19 compared to other conditions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 21:03:02","doi":"10.21203/rs.3.rs-4582926/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c106ae1d-de7f-4cbc-b766-2edeae3ae973","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-02T13:38:21+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-18 21:03:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4582926","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4582926","identity":"rs-4582926","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}