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Published on: December 19, 2020
Can laboratory findings predict pulmonary involvement in children with COVID-19 infection?
Elif Böncüoğlu1, Mehmet Coşkun2, Elif Kıymet1
1Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey.
Insights
Elevated fibrinogen levels may predict lung involvement in pediatric COVID-19 patients. This finding could help guide the use of chest imaging in children with coronavirus disease 2019 symptoms.
Area of Science:
- Pediatric infectious diseases
- Pulmonology
- Medical imaging
Background:
- Adult COVID-19 research often overlooks pediatric lung injury predictors.
- Limited data exists on laboratory markers for predicting lung involvement in children with COVID-19.
Purpose of the Study:
- To investigate laboratory findings as predictors of lung involvement in pediatric COVID-19 patients.
- To evaluate the role of specific blood markers in identifying pulmonary complications.
Main Methods:
- Retrospective review of 101 children with confirmed COVID-19 who underwent chest CT.
- Comparison of laboratory markers including neutrophil count, lymphocyte count, D-dimer, fibrinogen, ferritin, CRP, and LDH between normal and abnormal CT scans.
Main Results:
- Pulmonary involvement was observed in 32.7% of children.
- Significantly higher median levels of C-reactive protein (CRP), ferritin, and fibrinogen were found in children with abnormal CT findings.
- Logistic regression indicated a 1.021 times increased likelihood of abnormal CT for each unit increase in fibrinogen.
Conclusions:
- Fibrinogen levels show potential as a predictive marker for pulmonary involvement in pediatric COVID-19.
- Selective use of chest imaging in children with significant symptoms and elevated fibrinogen may optimize resource allocation.
Background:
Studies investigating clinical and imaging findings of coronavirus disease 2019 (COVID-19) pneumonia and predictors for lung injury mostly focus on adults. In this study, we aimed to evaluate the role of laboratory findings in predicting lung involvement in children with COVID-19.
Methods:
Children with COVID-19 confirmed by reverse-transcription polymerase chain reaction or COVID-19 IgM and who underwent chest computed tomography (CT) scans were reviewed retrospectively. Admission absolute neutrophil count (ANC), absolute lymphocyte count (ALC), ANC/ALC ratio, platelet count, D-dimer, fibrinogen, ferritin, procalcitonin, C-reactive protein (CRP), and lactate dehydrogenase levels were compared in patients with normal and abnormal CT scans.
Results:
A total of 101 children were included. Among the patients, 68 (67.3%) had normal CT scans, and 33 (32.7%) had pulmonary involvement. The median CRP, ferritin, and fibrinogen levels were significantly higher in children with abnormal CT findings. The model of binary logistic regression based on the presence of cough, shortness of breath, fibrinogen, ferritin, and CRP levels showed that the possibility of having abnormal CT was 1.021 times more likely for every one unit increase in fibrinogen levels.
Conclusion:
Fibrinogen might be useful to predict pulmonary involvement of COVID-19 in children. Restricting radiological imaging to patients with significant symptoms and high fibrinogen levels might be helpful in children with COVID-19 infections.
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