SARS-CoV-2 Infection: Differences in Hematological Parameters Between Adults and Children

Diagnostic value of routine blood tests in differentiating between SARS-CoV-2, influenza A, and RSV infections in hospitalized children: a retrospective study

BACKGROUND

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), influenza A, and respiratory syncytial virus (RSV) infections have similar modes of transmission and clinical symptoms. There is a need to identify simple diagnostic indicators to distinguish these three infections, particularly for community hospitals and low- and middle-income countries that lack nucleic acid detection kits. This study used clinical data to assess the diagnostic value of routine blood tests in differentiating between SARS-CoV-2, influenza A, and RSV infections in children.

METHODS

A total of 1420 children treated at the Hangzhou Children's Hospital between December 2022 and June 2023 were enrolled in this study, of whom 351 had SARS-CoV-2, 671 had influenza, and 398 had RSV. In addition, 243 healthy children were also collected. The blood test results of SARS-CoV-2 patients were compared to those of patients with influenza A and RSV and the healthy controls. The area under the receiver operating characteristic curve (AUC-ROC) was employed to evaluate each blood parameter's diagnostic value.

RESULTS

Children with SARS-CoV-2 exhibited notably elevated levels of white blood cell (WBC) count, platelet (PLT) count, neutrophil count, and neutrophil-to-lymphocyte ratio (NLR) compared to influenza A patients (P < 0.05). In contrast, SARS-CoV-2 patients exhibited a decrease in the mean platelet volume to platelet count ratio (MPV/PLT) and the lymphocyte-to-monocyte ratio (LMR) when compared to other individuals (P < 0.05). These parameters had an AUC between 0.5 and 0.7. Compared to patients with RSV, SARS-CoV-2 patients had significantly higher MPV/PLT and significantly lower WBC, lymphocyte, PLT, LMR, and lymphocyte multiplied by platelet (LYM*PLT) values (P < 0.05). However, only LYM*PLT had an acceptable diagnostic value above 0.7 for all age groups. Compared to healthy children, children with COVID-19 exhibited elevated NLR and MPV/PLT levels, alongside decreased lymphocyte, PLT, LMR, and LYM*PLT values. (P < 0.05). The AUC of the LMR, LYM*PLT, and PLT were above 0.7 in all age groups, indicating promising diagnostic values.

CONCLUSIONS

The routine blood parameters among patients with COVID-19, influenza A, and RSV differ significantly early in the disease and could be used by clinicians to discriminate between the 3 types of infection.

Vitamin D Levels in COVID-19 and NonCOVID-19 Pediatric Patients and Its Relationship with Clinical and Laboratory Characteristics

25-hydroxyvitamin D [25(OH)D] is a marker with an important role in regulating the inflammatory response. Low concentrations of this vitamin are often found among the population, correlated with increased risk of respiratory tract infections. The aim of the study is to evaluate the relationship between vitamin D levels and clinical and laboratory markers in children and adolescents hospitalized with and without COVID-19. A retrospective study, including all patients tested for SARS-CoV-2 and having vitamin D measured, was performed. All included hospitalized cases, 78 COVID-19 patients and 162 NonCOVID-19 patients, were divided into subgroups according to their 25(OH)D serum levels (<20 ng/mL-deficiency, 20-30 ng/mL-insufficiency, ≥30 ng/mL-normal or <30 ng/mL, ≥30 ng/mL) and age (≤2 years, >2 years). Vitamin D deficiency and insufficiency increased with age, in both COVID-19 and NonCOVID-19 groups. All symptoms were encountered more frequently in cases of pediatric patients with COVID-19 in comparison with NonCOVID-19 cases. The most frequently encountered symptoms in the COVID-19 group were fever, loss of appetite, and nasal congestion. In the NonCOVID-19 group, serum 25(OH)D concentrations were positively correlated with leukocytes, lymphocytes, and LMR and negatively correlated with neutrophils, NLR, and PLR while no significant correlation was observed in the case of COVID-19 group. Differences between vitamin D status and clinical and laboratory parameters were observed, but their clinical significance should be interpreted with caution. The results of this study may offer further support for future studies exploring the mechanisms of the relationship between vitamin D and clinical and laboratory markers as well as for studies investigating the implications of vitamin D deficiency/supplementation on overall health/clinical outcomes of patients with/without COVID-19.

Hematological profile, inflammatory markers and serum liver enzymes in COVID 19 positive children vs. COVID 19 negative ones-a comparative study

Background

Complete blood count, C-reactive protein and transaminases are routine laboratory parameters investigated in children with infections, including COVID 19. We aimed to evaluate the diagnostic accuracy of these parameters in children diagnosed with COVID 19.

Methods

At the time of admission, children with COVID 19 suggestive symptoms were tested RT-PCR for SARS CoV-2 and were allocated to either the study group (RT-PCR SARS CoV-2 positive) or control group (RT-PCR SARS CoV-2 negative). All children were evaluated by complete blood count, CRP, and transaminases.

Results

When comparing the two groups, we identified significantly lower values for leukocytes (p < 0.001), neutrophils (p < 0.001), lymphocytes (p < 0.001) and thrombocytes (p = 0.014), but no significantly different values for CRP (p = 0.916) and monocytes (p = 0.082). A diagnostic score for COVID-19 was compiled using the abovementioned parameters-presence of fever, number of lymphocytes and aspartate-aminotransferase. Performance was tested, showing a positive discrimination value (AUC of 0.703)-81.5% sensitivity, 50.6% specificity.

Conclusions

The leukocytes, neutrophils and lymphocytes have significantly lower values in COVID-19 children. The proposed score based on the presence of fever the values of lymphocytes and AST has a good sensitivity in predicting COVID-19 infection.

Biomarker Changes in Pediatric Patients With COVID-19: A Retrospective Study from a Single Center Database

BACKGROUND/AIM

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for generating a global pandemic with deadly consequences and life changes worldwide. With the appearance of the new variants of the virus, clinical manifestations have been reported in the pediatric population, some with severe evolution. The aim of this study was to identify the laboratory parameters necessary to establish an effective therapy.

PATIENTS AND METHODS

In the period from August 2020 to September 2021, 234 pediatric patients met the inclusion criteria and were selected for the study. After confirming the COVID-19 diagnosis, laboratory parameters were analyzed and compared to the severity of the illness.

RESULTS

Thrombocytopenia (p<0.001), leukocytosis (p<0.001), and lymphopenia (p<0.001) correlated with the severity of the disease. Also, D-dimer values were closely monitored due to the high association of this parameter with an unsatisfactory prognosis and a severe form of the disease.

CONCLUSION

The D-dimer values and complete blood count are useful parameters in COVID-19 evaluation in children.

Deep venous thrombosis and acute pericarditis associated with severe acute respiratory syndrome coronavirus 2 infection in a Congolese infant with sickle cell disease: a case report

Background

Since the beginning of the pandemic, no severe pediatric coronavirus disease 2019 cases have been described in Congo.

Case

We studied a 3-month-old male child of Congolese origin who was admitted to the pediatric department with 7-day history of fever, unilateral lower leg swelling, and dyspnea. There was no known history of contact with a coronavirus disease 2019 patient, and all the family members were asymptomatic. Nasopharyngeal swabs done at admission did not detect severe acute respiratory syndrome coronavirus 2. However, serology tests for severe acute respiratory syndrome coronavirus 2 antibodies were positive for immunoglobulin M and negative for immunoglobulin G. Hemoglobin electrophoresis showed hemoglobin A1, hemoglobin A2, hemoglobin F, and hemoglobin S of 46.2%, 2.5%, 19.9%, and 38.4%, respectively. Chest X-ray showed retrocardiac pneumonia in the left lung, and Doppler ultrasound of the left lower limb showed a recent total femoropopliteal venous thrombosis. At day 10 of hospitalization, our patient had classical signs of cardiac tamponade with a voluminous pericardial effusion seen on echocardiographic examination and elevated C-reactive protein, compatible with a diagnosis of constrictive pericarditis. To the best of the authors’ knowledge, this is the first report of a case of plausible severe acute respiratory syndrome coronavirus 2 infection associated with venous thrombosis and acute pericarditis in Congo.

Conclusion

We hypothesized that this case of venous thrombosis and acute pericarditis in a Congolese child with heterozygous sickle cell disease was related to severe acute respiratory syndrome coronavirus 2 infection.

A retrospective study of age-defined hematologic inflammatory markers related to pediatric COVID-19 diagnosis

Background

The aim of this study was to examine age‐related differences in hemogram parameters and hematologic inflammatory markers in pediatric patients with COVID‐19.

Methods

This retrospective study included children aged 2 months to 18 years (n = 208) who have a confirmed diagnosis of COVID‐19 and a control group comprising 117 healthy children between February 2021 and July 2021. The analysis of subgroup hematological values were performed according to the children's age cutoffs.

Results

The most significant difference between pediatric patients with COVID‐19 and controls were peripheral blood eosinophil counts and eosinophil‐to‐monocyte ratio (EMR) levels on admission. The levels of monocyte‐to‐lymphocyte ratio, aggeregate index of systemic inflammation (neutrophil × platelet × monocyte/lymphocyte), neutrophil‐to‐ lymphocyte × platelet ratio, and systemic inflammation response index (neutrophil × monocyte/ lymphocyte) were higher in patients than in controls. EMR had the highest area under the curve (AUC) value of 0.777, with a cutoff value of 0.26. The sensitivity for EMR was 75% under 2 years of age, and between 78.6–87.5% in the other age groups.

Conclusion

In children younger than 6 months, the discriminative power of hematological indices is low, while the discriminative power of EMR is high at all ages when age appropriate cutoffs are used. Hematological inflammatory parameters may be particularly practical in pediatric clinics to help identify COVID‐19 infection.

Progress in the Diagnosis and Treatment of COVID-19 in Children: A Review

Coronavirus disease 2019 (COVID-19) has been circulating in many countries around the world, characterized by long incubation period, strong infectivity, strong variability, high population susceptibility and diversified transmission methods. Its causative agent is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Compared with adult patients, the clinical manifestations of COVID-19 in children are often dominated by mild or asymptomatic infections, but children are also important virus carriers and play an important role in the transmission of the virus. In addition, some children will show excessive inflammatory response and experience serious complications such as multisystem inflammatory syndrome in children (MIS-C). At present, the research on COVID-19 in children is still imperfect. This article will review epidemiological characteristics, the mechanism of action, variant characteristics, clinical manifestations, auxiliary examinations and treatment of children with COVID-19, in order to provide help for the diagnosis, treatment and research of children with COVID-19.