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Impact of SARS-CoV-2 Infection on the Association Between Laboratory Tests and Severe Outcomes Among Hospitalized
Jianling Xie1, Nathan Kuppermann2, Todd A Florin3
1University of Calgary, Calgary, Alberta, Canada.
Insights
Specific laboratory markers, including procalcitonin, ferritin, D-dimer, glucose, lymphocyte, and platelet counts, predict severe outcomes in children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These associations are stronger in SARS-CoV-2 positive children.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Laboratory Science
- Epidemiology
Background:
- Identifying children at risk for severe outcomes from SARS-CoV-2 infection is crucial for clinical management.
- Laboratory findings can provide valuable insights into disease severity and prognosis in pediatric patients.
Purpose of the Study:
- To assess the association between specific laboratory findings and severe outcomes in children infected with SARS-CoV-2.
- To determine if SARS-CoV-2 test result status modifies these associations.
Main Methods:
- Cross-sectional analysis of 1817 children hospitalized across 41 pediatric emergency departments in 10 countries.
- Inclusion criteria: hospitalization, laboratory testing, and 14-day follow-up.
- Regression analysis to evaluate associations between laboratory markers and severe outcomes, with interaction analysis for SARS-CoV-2 status.
Main Results:
- Among SARS-CoV-2 positive children, elevated procalcitonin, ferritin, D-dimer, glucose, and reduced lymphocyte and platelet counts were significantly associated with severe outcomes.
- A positive SARS-CoV-2 test amplified the association between severe outcomes and elevated procalcitonin, CRP, D-dimer, and reduced lymphocyte and platelet counts.
Conclusions:
- Specific laboratory parameters are key indicators of severe outcomes in pediatric SARS-CoV-2 infections.
- Elevated procalcitonin, CRP, D-dimer, and low lymphocyte/platelet counts show a stronger association with severe outcomes in SARS-CoV-2 positive children compared to those testing negative.
Background:
To assist clinicians with identifying children at risk of severe outcomes, we assessed the association between laboratory findings and severe outcomes among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children and determined if SARS-CoV-2 test result status modified the associations.
Methods:
We conducted a cross-sectional analysis of participants tested for SARS-CoV-2 infection in 41 pediatric emergency departments in 10 countries. Participants were hospitalized, had laboratory testing performed, and completed 14-day follow-up. The primary objective was to assess the associations between laboratory findings and severe outcomes. The secondary objective was to determine if the SARS-CoV-2 test result modified the associations.
Results:
We included 1817 participants; 522 (28.7%) SARS-CoV-2 test-positive and 1295 (71.3%) test-negative. Seventy-five (14.4%) test-positive and 174 (13.4%) test-negative children experienced severe outcomes. In regression analysis, we found that among SARS-CoV-2-positive children, procalcitonin ≥0.5 ng/mL (adjusted odds ratio [aOR], 9.14; 95% CI, 2.90-28.80), ferritin >500 ng/mL (aOR, 7.95; 95% CI, 1.89-33.44), D-dimer ≥1500 ng/mL (aOR, 4.57; 95% CI, 1.12-18.68), serum glucose ≥120 mg/dL (aOR, 2.01; 95% CI, 1.06-3.81), lymphocyte count <1.0 × 109/L (aOR, 3.21; 95% CI, 1.34-7.69), and platelet count <150 × 109/L (aOR, 2.82; 95% CI, 1.31-6.07) were associated with severe outcomes. Evaluation of the interaction term revealed that a positive SARS-CoV-2 result increased the associations with severe outcomes for elevated procalcitonin, C-reactive protein (CRP), D-dimer, and for reduced lymphocyte and platelet counts.
Conclusions:
Specific laboratory parameters are associated with severe outcomes in SARS-CoV-2-infected children, and elevated serum procalcitonin, CRP, and D-dimer and low absolute lymphocyte and platelet counts were more strongly associated with severe outcomes in children testing positive compared with those testing negative.
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