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We aimed to describe characteristics and evaluate the factors associated to in-hospital mortality of patients with critical COVID-19\/MIS-C in the Amazonian region. This multicenter prospective cohort included critically ill children (1 mo\u201318\u00a0years old), with confirmed COVID-19\/MIS-C admitted to 3 tertiary Pediatric Intensive Care Units (PICU) in the Brazilian Amazon, between April\/2020 and May\/2023.\u00a0The main outcome was in-hospital mortality and were evaluated using a multivariable Cox proportional regression. We adjusted the model for pediatric risk of mortality score version IV (PRISMIV) score and age\/comorbidity. 266 patients were assessed with 187 in the severe COVID-19 group, 79 included in the MIS-C group. In the severe COVID-19 group 108 (57.8%) were male, median age was 23\u00a0months, 95 (50.8%) were up to 2\u00a0years of age. Forty-two (22.5%) patients in this group died during follow-up in a median time of 11\u00a0days (IQR, 2\u201328). In the MIS-C group, 56 (70.9%) were male, median age was 23\u00a0months and median follow-up was 162\u00a0days (range, 3\u2013202). Death occurred in 17 (21.5%) patients with a median death time of 7 (IQR, 4\u201313) days. The mortality was associated with higher levels of Vasoactive Inotropic-Score (VIS), presence of acute respiratory distress syndrome (ARDS), higher levels of Erythrocyte Sedimentation Rate, (ESR) and thrombocytopenia. Critically ill patients with severe COVID-19 and MIS-C from the Brazilian Amazon showed a high mortality rate, within 12\u00a0days of hospitalization.<\/jats:p>","DOI":"10.1038\/s41598-024-55065-x","type":"journal-article","created":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T12:01:45Z","timestamp":1709726505000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Factors associated to mortality in children with critical COVID-19 and multisystem inflammatory syndrome in a resource-poor setting"],"prefix":"10.1038","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8627-5694","authenticated-orcid":false,"given":"Emmerson C. F.","family":"de Farias","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5685-9947","authenticated-orcid":false,"given":"Manoel J. 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