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Separation of Immune Cell Subpopulations in Peripheral Blood Samples from Children with Infectious Mononucleosis
Published on: September 7, 2022
Monocyte anisocytosis corresponds with increasing severity of COVID-19 in children
Abigail S Kane1,2, Brittany P Boribong1,2,3, Maggie Loiselle1,2
1Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States.
Insights
Monocyte anisocytosis, measured by monocyte distribution width (MDW), is a sensitive biomarker for severe COVID-19 in children. This finding aids in early risk assessment for pediatric SARS-CoV-2 infections.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- COVID-19 Research
Background:
- Severe COVID-19 in children requires reliable biomarkers for risk assessment.
- Monocyte signatures are linked to COVID-19 severity in adults.
Purpose of the Study:
- To investigate if monocyte anisocytosis correlates with COVID-19 severity in children.
- To identify effective hematologic biomarkers for pediatric COVID-19.
Main Methods:
- Multicenter retrospective study of 215 children.
- Quantified monocyte anisocytosis using monocyte distribution width (MDW).
- Analyzed association between MDW and COVID-19 severity.
Main Results:
- Monocyte anisocytosis (MDW) increased with COVID-19 severity and hospitalization need.
- MDW was more sensitive than other inflammatory markers for severe pediatric disease.
- An MDW threshold of 23 showed sensitivity for severe pediatric COVID-19.
Conclusions:
- Monocyte anisocytosis reflects inflammatory changes in pediatric COVID-19.
- MDW is a clinically accessible biomarker for identifying severe COVID-19 in children.
Introduction:
Although SARS-CoV-2 infection can lead to severe COVID-19 in children, the role of biomarkers for assessing the risk of progression to severe disease is not well established in the pediatric population. Given the differences in monocyte signatures associated with worsening COVID-19 in adults, we aimed to determine whether monocyte anisocytosis early in the infectious course would correspond with increasing severity of COVID-19 in children.
Methods:
We performed a multicenter retrospective study of 215 children with SARS-CoV-2 infection, Multisystem Inflammatory Syndrome in Children (MIS-C), convalescent COVID-19, and healthy age-matched controls to determine whether monocyte anisocytosis, quantified by monocyte distribution width (MDW) on complete blood count, was associated with increasing severity of COVID-19. We performed exploratory analyses to identify other hematologic parameters in the inflammatory signature of pediatric SARS-CoV-2 infection and determine the most effective combination of markers for assessing COVID-19 severity in children.
Results:
Monocyte anisocytosis increases with COVID-19 severity and need for hospitalization. Although other inflammatory markers such as lymphocyte count, neutrophil/lymphocyte ratio, C-reactive protein, and cytokines correlate with disease severity, these parameters were not as sensitive as MDW for identifying severe disease in children. An MDW threshold of 23 offers a sensitive marker for severe pediatric COVID-19, with improved accuracy when assessed in combination with other hematologic parameters.
Conclusion:
Monocyte anisocytosis corresponds with shifting hematologic profiles and inflammatory markers in children with COVID-19, and MDW serves as a clinically accessible biomarker for severe COVID-19 in children.
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