Coagulation disorders in pediatric patients hospitalized due to SARS-CoV- 2 infection

ABSTRACT

Background: Haemostatic impact of SARS-CoV- 2 infection and multisystem inflammation syndrome (MIS-C) in children is still under consideration. Aim(s) To investigate COVID-19 coagulopathy in hospitalized children due to SARS-CoV- 2 infection. Method(s) A retrospective review on coagulation parameters of children with SARS-CoV- 2 infection and MIS-C hospitalized from August 2020 until December 2021 was conducted in our Haemostasis and Thrombosis Centre. Values of D-dimers, fibrinogen, antithrombin, protein C, PT, APTT and the respective coagulation factors were recorded at hospital admission, in multiple time points during hospitalization and upon hospital discharge. Statistical analysis was performed with Mann-Whitney test and t-test. Result(s) In total, 733 children (boys 62.7%) of mean age 4.9 +/- 5.4 years (0-18) were investigated. Patients were categorized as follows Patients with mild/moderate (87.6%) or severe COVID-19 (6.3%) and patients with MIS-C (6.1%). Severe, in comparison with mild/moderate patients, had significantly increased admission D-Dimer values (34.3 vs. 2.9 mug/ml), PT (25.2 vs. 14.3, sec), APTT (62.5 vs. 34.6, sec), fibrinogen (362.5 vs. 259.5, mg %), and factor VIII values (165.4 vs. 126.9, %). MIS-C children had significantly increased admission values of fibrinogen (501 mg %), factor VIII (200.3, %) and statistically decreased factor VII values (38.2 vs. 56.6, %), antithrombin values (81.5 vs. 98.1, %) and protein C values (52.4 vs. 63.3, %) in comparison with mild/ moderate patients. Interestingly, MIS-C children had markedly increased fibrinogen and factor VIII values even in comparison with severe patients. During hospitalization, PT, APTT, fibrinogen, factor VIII values were significantly decreased and factor VII values increased. Also, D-Dimers values were markedly decreased but without statistical significance. No child died and thrombosis was noticed in three children, one of which was suffered from MIS-C. Conclusion(s) Our COVID19 hospitalized children showed a mild deterioration of coagulation parameters. However, in children with MIS-C and severe COVID19, these coagulation parameters were found mainly affected.