AUTHOR=Sossa-Alarcón María Camila , Gutiérrez Mónica Paola , Becerra Natalia , Ortegon Luz Yessenia , David María Camila , Vanegas Melisa Naranjo , Friedrich Gabriela , Vásquez-Hoyos Pablo , Mesa-Rubio María Lucía , Navarro-Ramirez Luis Miguel , Moreno-Lopez Sergio , Baquero Olga Lucía , Mejía Luz Marina , Piñeros Juan Gabriel , Restrepo-Gualteros Sonia , Álvarez-Moreno Carlos , Díaz-Díaz Alejandro , Gutierrez-Tobar Iván , Mesa Andrés Camilo , Bachiller Tuta William Ricardo , Galvis Diaz Clara Esperanza , Africano Martha , Nieto José Manuel , Pérez Camacho Paola Marsela , Beltrán-Arroyave Claudia , Vivas Trochez Rosalba , Gastesi Irati , Moraleda Cinta , Tagarro García Alfredo , Herrero Blanca , Calleja Lourdes , Grasa Carlos , Rodriguez Paula , Melendo Susana , Soriano-Arandes Antoni , Gómez Pastrana Irene , García García Sonsoles , Fumado Victoria , Ramírez Varela Andrea 

TITLE=Phenotypic Variation in Disease Severity Among Hospitalized Pediatric Patients With COVID-19: Assessing the Impact of COVID-19 in the EPICO Study

JOURNAL=International Journal of Public Health

VOLUME=Volume 70 - 2025

YEAR=2025

URL=https://www.ssph-journal.org/journals/international-journal-of-public-health/articles/10.3389/ijph.2025.1607246

DOI=10.3389/ijph.2025.1607246

ISSN=1661-8564

ABSTRACT=SARS-CoV-2 infection has been extensively documented since the onset of the pandemic.However, there is a lack of evidence describing the phenotypic manifestations of the disease in the pediatric population. We aimed to characterize the clinical phenotypes of SARS-CoV-2 infection in hospitalized children, as a branch of the multicenter cohort: the EPICO study.Hospitalized children with confirmed SARS-CoV-2 infection were included to determine the disease's evolution and outcomes. Cluster analysis was conducted to characterize clinical phenotypes. A total of 2318 patients from Colombian and Spanish institutions were included, 55% were male, with infants being the largest age group (36%). Five distinct phenotype clusters emerged: Cluster 1 (26.5%): infants without comorbidities, with low PICU admission and mortality rates; Cluster 2 (18.5%): respiratory comorbidities, high microorganism co-detection, and mortality rates; Cluster 3 (11.5%): fever, gastrointestinal symptoms, and high PICU admission; Cluster 4 (32%): had mild unspecific symptoms and low mortality; Cluster 5 (11.3%): adolescents without comorbidities, low co-detection and hospitalization rates. Comparable findings were observed in both countries. These findings may help shape future guidelines and improve risk stratification in children.