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 Marcela , 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=70 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=Objective

To characterize the clinical phenotypes of SARS-CoV-2 infection in hospitalized children as part of the EPICO multicenter cohort study.

Methods

We included hospitalized children with confirmed SARS-CoV-2 infection from Colombian and Spanish institutions to assess disease evolution and outcomes. Cluster analysis was performed to identify clinical phenotypes.

Results

A total of 2318 patients were included (55% male, 36% infants). Five phenotype clusters emerged: Cluster 1 (26.5%): infants without comorbidities, low PICU admissions and mortality; Cluster 2 (18.5%): respiratory comorbidities, high microorganism co-detection and mortality; Cluster 3 (11.5%): fever, gastrointestinal symptoms, high PICU admissions; Cluster 4 (32%): mild unspecific symptoms, low mortality; Cluster 5 (11.3%): adolescents without comorbidities, low co-detection and hospitalization rates. Findings were consistent across both countries.

Conclusion

Identifying clinical phenotypes of SARS-CoV-2 in children may improve risk stratification and guide future management strategies.