ABSTRACT
Objective: We aimed to evaluate the demographic, epidemiological, and clinical characteristics of children with coronavirus disease-2019 (COVID-19), and to determine variations of the clinical presentation of the disease by age. Method: A total of 104 confirmed COVID-19 patients aged between 0-18 years were retrospectively analyzed. The study period was between March 15, 2020 and July 1, 2020. A confirmed COVID-19 was defined as a child who has positive real-time reverse transcription-polymerase chain reaction (rRT-PCR). The patients were analyzed in terms of demographic, epidemiological, clinical, laboratory and imaging features, and clinical outcomes.
ABSTRACT
Objective: It is thought that hyperinflammation has an important role in the pathogenesis of severe COVID-19 and tests that determine the de-gree of inflammation can be used to predict the severity of the disease. From this point of view, we aimed to determine the hematological parameters that can predict the severity of COVID-19 in pediatric patients. Material and Methods: Symptomatic and SARS-CoV-2-PCR test positive 105 children were included to study. Seventy-nine patients had mild, 26 had moderate to severe COVID-19 at admission. Data about their demo-graphic characteristics, clinical and laboratory findings were collected from their medical records. Correlations between the hematological parameters and disease severity of patients were investigated by using uni-variate and multivariate regression analyses. Predictive value of different diagnostic markers was studied. Results: Mean age was older (177 months vs. 70 months) and mean body mass index (BMI) was higher (18.8 kg/m2 vs. 25.0 kg/m2) in patients with severe COVID-19 than those with mild. Univariate analysis showed that mean leucocyte (WBC), lymphocyte, eosinophiles, and platelet counts were lower;mean platelet volume (MPV), neutrophil to lympho-cyte ratio (NLR), and derived neutrophil to lymphocyte ratio (dNLR) were higher in severe COVID-19 group (p< 0.05). Multivariant analysis showed low lymphocyte (OR 0.072) and WBC count (OR 0.085), high dNLR (OR 2.14) and MPV (OR 2.35) indexes were the most valuable parameters to predict disease severity, ROC curve analysis revealed lymphocyte count has superior predictive value (<1.55 /mm3 has 84.6% sensitivity, 70.9% specificity) than other CBC parameters have. Conclusion: Low lymphocyte and leukocyte count, high MPV and dNLR values have significant predictive value in predicting COVID-19 severity. In particular, lymphopenia appears to be a valuable parameter to identify patients at high risk for severe disease and initiate accurate treatment to prevent disease deterioration.
ABSTRACT
OBJECTIVE: To determine the viral etiology of severe lower respiratory tract infections (LRTIs), their clinical significance and prognosis among critically ill children. DESIGN: A prospective descriptive study was carried out. SETTING: Pediatric Intensive Care Unit (PICU) of Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey. PATIENTS: A total of 115 patients hospitalized in the PICU were evaluated for inclusion in the study. Children with underlying comorbidities and those who did not require mechanical ventilation were excluded. MAIN VARIABLES OF INTEREST: Demographic, clinical, laboratory test and radiographic data were recorded. RESULTS: A total of 63 patients were eligible for the study. The most common diagnosis was bronchiolitis (57.1%). Respiratory syncytial virus (RSV) was the most frequent causal virus (36.5%). The most common complication was acute respiratory distress syndrome (ARDS) (28.6%). Multiple viral infection was identified in 20.6% of the patients, the most common in this subgroup being rhinovirus. Patients with bocavirus infection had a higher likelihood of needing invasive mechanical ventilation (IMV) at presentation. Children who died were likely to be <12 months old, have ARDS, hepatitis, pneumomediastinum, multiple viral infection, and required IMV support with an increased duration of MV. Additionally, they were found to have a high Pediatric Risk of Mortality III score, Predicted Death Rate and increased need for inotropic support at admission. CONCLUSIONS: Our study showed critically ill children with LRTI without known risk factors to have high mortality when aged <12 months, in the presence of multiple agents and when certain complications (ARDS, hepatitis) and X-ray findings were identified.