A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral

Abstract

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs).
 Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings.
 Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran.
 Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001).
 Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions.

Prognosis of COVID-19 in the middle eastern population, knowns and unknowns

“…It was found that the most common symptoms reported in children, i.e., <18 years old, are cough and dyspnea ( Rabizadeh et al, 2020 ; Fahimzad et al, 2021 ) and fever and cough ( Hosseninasab et al, 2020 ; Mahmoudi et al, 2020 ; Armin et al, 2021 ; Hoseinyazdi et al, 2021 ; Mamishi et al, 2021 ; Soleimani et al, 2021 ; Keshavarz Valian et al, 2022 ). Gastrointestinal symptoms including vomiting, nausea, and diarrhea were reported but to a lesser extent ( Hosseninasab et al, 2020 ; Mamishi et al, 2020 ; Armin et al, 2021 ; Fahimzad et al, 2021 ; Pourakbari et al, 2021 ). Interestingly, neurological symptoms such as seizure, fatigue, and headache were also described ( Cheraghali et al, 2021 ; Fahimzad et al, 2021 ).…”

“…Gastrointestinal symptoms including vomiting, nausea, and diarrhea were reported but to a lesser extent ( Hosseninasab et al, 2020 ; Mamishi et al, 2020 ; Armin et al, 2021 ; Fahimzad et al, 2021 ; Pourakbari et al, 2021 ). Interestingly, neurological symptoms such as seizure, fatigue, and headache were also described ( Cheraghali et al, 2021 ; Fahimzad et al, 2021 ). In one study, it was found that among hospitalized children with acute respiratory infection, those with COVID-19 had a higher frequency of respiratory distress and fever compared to those without ( Hosseninasab et al, 2020 ).…”

“…Furthermore, laboratory findings showed that hospitalized children with COVID-19 are more likely to have elevated inflammatory markers such as C-reactive protein, erythrocyte sedimentation rate (ESR), liver enzymes like alanine aminotransferase and aspartate aminotransferase ( Armin et al, 2021 ; Hoseinyazdi et al, 2021 ; Mamishi et al, 2021 ); leukocytosis and leukopenia were also observed in one study ( Armin et al, 2021 ). Prognosis of COVID-19 in Iranian children ranges from mild ( Armin et al, 2021 ; Fahimzad et al, 2021 ) to severe disease ( Mahmoudi et al, 2020 ; Ghazizadeh Esslami et al, 2021 ; Mamishi et al, 2021 ). In two studies, the SARS-CoV-2 infection manifested as a hyperinflammatory syndrome with multi-organ involvement similar to Kawasaki disease shock syndrome ( Mamishi et al, 2021 ) and as MIS-C ( Mamishi et al, 2020 ).…”

“…In one study that reported severe infection in children, 51% of the patients had underlying medical conditions such as chronic kidney disease, neurological disorders, and others ( Mahmoudi et al, 2020 ). In COVID-19 children, compared to those admitted to the general ward, ICU patients had more acute respiratory distress syndrome, shock, and acute cardiac injury as complications ( Fahimzad et al, 2021 ). The mortality rate appears to be low in infected children of Iran ( Hosseninasab et al, 2020 ; Armin et al, 2021 ; Hoseinyazdi et al, 2021 ; Mamishi et al, 2021 ; Pourakbari et al, 2021 ), ranging from 0 death ( Esmaeili Dooki et al, 2020 ; Soleimani et al, 2021 ) to 11% ( Mahmoudi et al, 2020 ; Mamishi et al, 2020 ; Armin et al, 2021 ).…”

“…It was found that the most common symptoms reported in children, i.e., <18 years old, are cough and dyspnea (Rabizadeh et al, 2020;Fahimzad et al, 2021) and fever and cough (Hosseninasab et al, 2020;Mahmoudi et al, 2020;Armin et al, 2021;Hoseinyazdi et al, 2021;Mamishi et al, 2021;Soleimani et al, 2021;Keshavarz Valian et al, 2022). Gastrointestinal symptoms including vomiting, nausea, and diarrhea were reported but to a lesser extent (Hosseninasab et al, 2020;Mamishi et al, 10.3389/fmicb.2022.974205 Frontiers in Microbiology 13 frontiersin.org Armin et al, 2021;Fahimzad et al, 2021;Pourakbari et al, 2021). Interestingly, neurological symptoms such as seizure, fatigue, and headache were also described (Cheraghali et al, 2021;Fahimzad et al, 2021).…”