Factors Associated With Severe Gastrointestinal Diagnoses in Children With SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome

26noImportance: Severe gastrointestinal (GI) manifestations have been sporadically reported in children with COVID-19; however, their frequency and clinical outcome are unknown. Objective: To describe the clinical, radiological, and histopathologic characteristics of children with COVID-19 presenting with severe GI manifestations to identify factors associated with a severe outcome. Design, setting, and participants: A multicenter retrospective cohort study (February 25, 2020, to January 20, 2021) enrolled inpatient and outpatient children (aged 10 years: OR, 6.37; 95% CI, 2.12-19.1, compared with preschool-age), abdominal pain (adjusted OR [aOR], 34.5; 95% CI, 10.1-118), lymphopenia (aOR, 8.93; 95% CI, 3.03-26.3), or MIS-C (aOR, 6.28; 95% CI, 1.92-20.5). Diarrhea was associated with a higher chance of adenomesenteritis (aOR, 3.13; 95% CI, 1.08-9.12) or abdominal fluid collection (aOR, 3.22; 95% CI, 1.03-10.0). Conclusions and relevance: In this multicenter cohort study of Italian children with SARS-CoV-2 infection or MIS-C, 9.5% of the children had severe GI involvement, frequently associated with MIS-C. These findings suggest that prompt identification may improve the management of serious complications.openopenLo Vecchio, Andrea; Garazzino, Silvia; Smarrazzo, Andrea; Venturini, Elisabetta; Poeta, Marco; Berlese, Paola; Denina, Marco; Meini, Antonella; Bosis, Samantha; Galli, Luisa; Cazzato, Salvatore; Nicolini, Giangiacomo; Vergine, Gianluca; Giacchero, Roberta; Ballardini, Giuseppina; Dodi, Icilio; Salvini, Filippo Maria; Manzoni, Paolo; Ferrante, Giuliana; Quadri, Vera; Campana, Andrea; Badolato, Raffaele; Villani, Alberto; Guarino, Alfredo; Gattinara, Guido Castelli; Gianluca TorneseLo Vecchio, Andrea; Garazzino, Silvia; Smarrazzo, Andrea; Venturini, Elisabetta; Poeta, Marco; Berlese, Paola; Denina, Marco; Meini, Antonella; Bosis, Samantha; Galli, Luisa; Cazzato, Salvatore; Nicolini, Giangiacomo; Vergine, Gianluca; Giacchero, Roberta; Ballardini, Giuseppina; Dodi, Icilio; Salvini, Filippo Maria; Manzoni, Paolo; Ferrante, Giuliana; Quadri, Vera; Campana, Andrea; Badolato, Raffaele; Villani, Alberto; Guarino, Alfredo; Gattinara, Guido Castelli; Tornese, Gianluc