Clinical analysis and early differential diagnosis of suspected pediatric patients with 2019 novel coronavirus infection

ABSTRACT

BackgroundWe aimed to identify clinical features of coronavirus disease 2019 (COVID-19) in children and evaluate the role of procalcitonin in early differential diagnosis. MethodsA retrospective analysis was performed on all suspected pediatric cases. Results39 (50.6%) of 77 suspected cases were comfirmed, 4 (5.2%) of them had viral coinfection. Compared with non-COVID-19 group (n=33), COVID-19 confirmed group (n=39) had fewer fever(OR[95% CI]0.467[0.314-0.694]; P=.000) and symptoms of acute respiratory infection (0.533[0.36-0.788]; P=.001), more asymptomatic (13.568[1.895-96.729]; P=.000), and more family cluster infections (5.077[2.224-11.591]; P=.000), while computed tomography had more positive findings of viral pneumonia (1.822[1.143-2.906]; P=.008). Age (6.9[3.6-10.5] vs 5[2.1-7.6]; P=. 088) and gender were statistically insignificant. Procalcitonin (0.05[0.029-0.076] vs 0.103[0.053-0.21]; P= 000) of COVID-19 alone group (n=35) was significantly reduced. While compared with coinfection group (n=4), procalcitonin (0.05[0.029-0.076] vs 0.144[0.109-2.26]; P=.010) was also reduced. The area under curve of model is 0.834 ([95% CI][0.741-0.926]; P=.000). Procalcitonin as a differential indicator of COVID-19 alone, its area under curve is 0.809 ([0.710-0.909]; P=.000). The optimal cut-off value is 0.1 ng/mL, the sensitivity, specificity, positive and negative predictive value of differentiating are 65.9%, 78.6%, 82.9%, and 59.2%, respectively. ConclusionsAsymptoms or mild symptoms, positive computed tomography findings and family cluster infection are the main clinical features of COVID-19 in children. With good performance, procalcitonin can provide an important basis for differentiating COVID-19 alone and other viral infection or viral coinfection.