ABSTRACT
Introduction or Background: The long-term effects of COVID-19 infection on the respiratory system in children are not yet known. Aims and Objectives: To determine the long-term effects of COVID-19 infection on the respiratory system of children by evaluating pulmonary function tests. Method(s): In this multicenter study, COVID-19 PCR positive children(>=6years) were evaluated prospectively with pulmonary function tests(spirometry, plethysmography and CO diffusion) at 3rd and 6th months follow-up. The results were evaluated retrospectively based on clinical symptoms, physical examination findings, radiological and laboratory tests of the patients in the acute phase of the infection. Result(s): At 3rd month evaluation of 270 COVID-19 PCR positive pediatric patients, mean FEV1 96.85+/-16.84%,FVC 96.06+/-16.84% were found;at 6th month, mean FEV1 100,03+/-15.98%,FVC 100.62+/-16.87. At the 3rd month, statistically significant differences were found between FEV1<80%(n:28),FEV1>80%(n:242) groups due to the presence of additional diseases(p<0.001),having respiratory(p=0.006) and cardiovascular(p=0.004) system pathological examination findings, interlobular septal thickening(p=0.020) on thorax CT, high level of CRP(p=0.032),IL6(p=0.048),ferritin(p=0,020) during the infection period. Having COVID-19 pneumonia was found to be non-effective on spirometric test results. No difference was found between the 3rd and 6th month spirometry results of the same patient. Conclusion(s): After recovery of COVID-19 infection, children who have additional diseases, and pathological examination and radiological findings during the infection period, may have functional respiratory changes;so they should be monitored with pulmonary function tests.
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.