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Changes in Hematological, Clinical and Laboratory Parameters for Children with COVID-19: Single-Center Experience
Mahasen Saleh1, Amani Alkofide1, Anfal Alshammari1
1Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, 11533, Kingdom of Saudi Arabia.
Insights
In children with COVID-19, elevated D-dimer and Factor VIII levels can predict critical care needs. While no thrombosis occurred, these markers are vital for assessing pediatric COVID-19 severity.
Area of Science:
- Pediatric Infectious Diseases
- Hematology
- Critical Care Medicine
Background:
- COVID-19 significantly impacted global healthcare systems.
- Pediatric COVID-19 patients, though fewer than adults, require prognostic factor identification due to varying clinical statuses.
- Understanding disease severity in children is crucial for targeted management.
Purpose of the Study:
- To investigate thrombosis incidence in pediatric COVID-19 patients.
- To analyze overall outcomes and hematological/coagulation markers in children with COVID-19.
- To identify prognostic factors for severe disease in pediatric COVID-19 cases.
Main Methods:
- A single-center prospective study included 43 pediatric patients (<14 years) diagnosed with COVID-19.
- Clinical data and presentation symptoms were systematically collected and analyzed.
- Hematological and coagulation markers, including D-dimer and Factor VIII, were assessed.
Main Results:
- Fever was the most common symptom (53.5%); 60.5% had comorbidities, with malignancy being most frequent (20.9%).
- Hypertension, respiratory symptoms, and blood group A were linked to pediatric intensive care unit (PICU) admission.
- Elevated Factor VIII and fibrinogen correlated with longer hospital stays; high D-dimer associated with PICU admission and extended LOS. No thrombotic events were observed.
Conclusions:
- Serial D-dimer measurements and elevated Factor VIII are prognostic for critical care needs in pediatric COVID-19.
- These markers can help predict the requirement for intensive care in children.
- Larger studies are recommended to establish definitive prognostic factors for pediatric COVID-19.
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.
