Changes in Hematological, Clinical and Laboratory Parameters for Children with COVID-19: Single-Center Experience

Abstract

Background: COVID-19 wreaked havoc on the healthcare system, with more than 36 million cases reported globally. Although the pediatric population makes up a lesser proportion of total COVID-19 patients than adults, the clinical status, age and comorbidities warrant identifying possible prognostic factors associated with disease severity in this group. The current study aimed to explore the incidence of thrombosis, overall outcome, and different hematological and coagulation markers in children with COVID-19. Methods: This is a single-center prospective study of 43 patients (age < 14 years) with confirmed COVID-19 diagnosis recruited from April to August 2020. Data for clinical presentation were collected and analyzed. The samples were tested for different hematological and coagulation markers. Results: Twenty-nine (67.4%) were symptomatic at presentation, with fever being the most common symptom (n = 23, 53.5%), followed by respiratory (n = 5, 11.6%) and gastrointestinal symptoms (n = 3, 7%). Co-morbid conditions were recorded in 26 (60.5%) patients, with malignancy being the commonest (n = 9, 20.9%). In this cohort of patients with age <14 years, hypertension, respiratory symptoms and ABO group-A were significantly associated with pediatric intensive care unit (PICU) admission during the course of treatment. Patients with elevated FVIII and fibrinogen levels at presentation were more likely to have an extended length of hospital stay (LOS) (P-value =0.036 and 0.032 respectively). No thrombotic event was observed in our cohort. D-dimer values were higher (above 0.5 µg/mL) in 24 (55.8%) patients at admission. We found an association between high D-dimer and PICU admission and LOS. Conclusion: Although we did not observe thrombosis in our cohort, serial measurements of D-dimer and elevated FVIII bear a prognostic value in predicting the need for critical care in children with COVID-19. Further studies with larger sample size can aid in the establishment of prognostic factors for the pediatric COVID-19 population.

COVID-19 in Pediatrics: Demographic, Clinical, Laboratory, and Radiological Characteristics of Infected Patients With SARS-CoV-2

“…Prolonged PT and elevated PT/INR (international normalized ratio) were detected significantly more often in deceased and ICU admitted children. In line with previous studies in adults and children (40,41), the correlation between coagulation irregularities and the disease severity was confirmed, indicating that liver dysfunction can be used as a marker for predicting the severity of COVID-19 in children (42). In this study, a tendency for increased severity was seen among cases with elevated AST, similar to results from a meta-analysis (43).…”

Investigation of the Molecular Mechanism of Coagulopathy in Severe and Critical Patients With COVID-19

“…Interestingly, factors including FVIII and vWF (which act as markers of endothelial activation) ( 53 ) were produced in the endothelial cells. Investigation of the levels of these factors in COVID-19 patients revealed that their levels increased and may correlate with poorer prognosis ( 54 – 56 ). We showed that D-dimer, fibrinogen, PT, PTT, LAC, protein S, FDPs, and protein C (ordered according to their p -values) could effectively be used in the prognosis of the severity of the disease and that disruptions in proteins C and S regulating the conversion of factors V and VIII to their active form may interfere the homeostasis of the coagulation system.…”

Evaluation of Clinical Findings and Treatment Results of Coronavirus Disease 2019 (COVID-19) in Pediatric Cancer Patients: A Single Center Experience

“…Pediatric patients with ongoing cancer treatment were included in the study. Patients were classified according to the “hospital-based clinical staging system for COVID-19” ( 8 , 9 ).…”