tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2023 Oct 3;10(10)
fad485.
doi: 10.1093/ofid/ofad485. eCollection 2023 Oct. Impact of SARS-CoV-2 Infection on the Association Between Laboratory Tests and Severe Outcomes Among Hospitalized Children
Jianling Xie[SUP] 1 [/SUP], Nathan Kuppermann[SUP] 2 [/SUP], Todd A Florin[SUP] 3 [/SUP], Daniel J Tancredi[SUP] 2 [/SUP], Anna L Funk[SUP] 1 [/SUP], Kelly Kim[SUP] 1 [/SUP], Marina I Salvadori[SUP] 4 [/SUP], Adriana Yock-Corrales[SUP] 5 [/SUP], Nipam P Shah[SUP] 6 [/SUP], Kristen A Breslin[SUP] 7 [/SUP], Pradip P Chaudhari[SUP] 8 [/SUP], Kelly R Bergmann[SUP] 9 [/SUP], Fahd A Ahmad[SUP] 10 [/SUP], Jasmine R Nebhrajani[SUP] 11 [/SUP], Santiago Mintegi[SUP] 12 [/SUP], Iker Gangoiti[SUP] 12 [/SUP], Amy C Plint[SUP] 13 [/SUP], Usha R Avva[SUP] 14 [/SUP], Michael A Gardiner[SUP] 15 [/SUP], Richard Malley[SUP] 16 [/SUP], Yaron Finkelstein[SUP] 17 [/SUP], Stuart R Dalziel[SUP] 18 [/SUP], Maala Bhatt[SUP] 19 [/SUP], Nirupama Kannikeswaran[SUP] 20 [/SUP], Kerry Caperell[SUP] 21 [/SUP], Carmen Campos[SUP] 22 [/SUP], Vikram J Sabhaney[SUP] 23 [/SUP], Shu-Ling Chong[SUP] 24 [/SUP], Maren M Lunoe[SUP] 25 [/SUP], Alexander J Rogers[SUP] 26 [/SUP], Sarah M Becker[SUP] 27 [/SUP], Meredith L Borland[SUP] 28 [/SUP], Laura F Sartori[SUP] 29 [/SUP], Viviana Pavlicich[SUP] 30 [/SUP], Pedro B Rino[SUP] 31 [/SUP], Andrea K Morrison[SUP] 32 [/SUP], Mark I Neuman[SUP] 16 [/SUP], Naveen Poonai[SUP] 33 [/SUP], Norma-Jean E Simon[SUP] 34 [/SUP], April J Kam[SUP] 35 [/SUP], Maria Y Kwok[SUP] 36 [/SUP], Claudia R Morris[SUP] 37 [/SUP], Laura Palumbo[SUP] 38 [/SUP], Lilliam Ambroggio[SUP] 39 [/SUP], Nidhya Navanandan[SUP] 39 [/SUP], Michelle Eckerle[SUP] 40 [/SUP], Terry P Klassen[SUP] 41 [/SUP], Daniel C Payne[SUP] 42 [/SUP], Jonathan C Cherry[SUP] 43 [/SUP], Muhammad Waseem[SUP] 44 [/SUP], Andrew C Dixon[SUP] 45 [/SUP], Isabel Beneyto Ferre[SUP] 46 [/SUP], Stephen B Freedman[SUP] 1 [/SUP]
Affiliations
Background: To assist clinicians with identifying children at risk of severe outcomes, we assessed the association between laboratory findings and severe outcomes among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children and determined if SARS-CoV-2 test result status modified the associations.
Methods: We conducted a cross-sectional analysis of participants tested for SARS-CoV-2 infection in 41 pediatric emergency departments in 10 countries. Participants were hospitalized, had laboratory testing performed, and completed 14-day follow-up. The primary objective was to assess the associations between laboratory findings and severe outcomes. The secondary objective was to determine if the SARS-CoV-2 test result modified the associations.
Results: We included 1817 participants; 522 (28.7%) SARS-CoV-2 test-positive and 1295 (71.3%) test-negative. Seventy-five (14.4%) test-positive and 174 (13.4%) test-negative children experienced severe outcomes. In regression analysis, we found that among SARS-CoV-2-positive children, procalcitonin ≥0.5 ng/mL (adjusted odds ratio [aOR], 9.14; 95% CI, 2.90-28.80), ferritin >500 ng/mL (aOR, 7.95; 95% CI, 1.89-33.44), D-dimer ≥1500 ng/mL (aOR, 4.57; 95% CI, 1.12-18.68), serum glucose ≥120 mg/dL (aOR, 2.01; 95% CI, 1.06-3.81), lymphocyte count <1.0 × 10[SUP]9[/SUP]/L (aOR, 3.21; 95% CI, 1.34-7.69), and platelet count <150 × 10[SUP]9[/SUP]/L (aOR, 2.82; 95% CI, 1.31-6.07) were associated with severe outcomes. Evaluation of the interaction term revealed that a positive SARS-CoV-2 result increased the associations with severe outcomes for elevated procalcitonin, C-reactive protein (CRP), D-dimer, and for reduced lymphocyte and platelet counts.
Conclusions: Specific laboratory parameters are associated with severe outcomes in SARS-CoV-2-infected children, and elevated serum procalcitonin, CRP, and D-dimer and low absolute lymphocyte and platelet counts were more strongly associated with severe outcomes in children testing positive compared with those testing negative.
Keywords: C-reactive protein; COVID-19; SARS-CoV-2; child; lymphopenia; procalcitonin.
. 2023 Oct 3;10(10)
fad485.doi: 10.1093/ofid/ofad485. eCollection 2023 Oct. Impact of SARS-CoV-2 Infection on the Association Between Laboratory Tests and Severe Outcomes Among Hospitalized Children
Jianling Xie[SUP] 1 [/SUP], Nathan Kuppermann[SUP] 2 [/SUP], Todd A Florin[SUP] 3 [/SUP], Daniel J Tancredi[SUP] 2 [/SUP], Anna L Funk[SUP] 1 [/SUP], Kelly Kim[SUP] 1 [/SUP], Marina I Salvadori[SUP] 4 [/SUP], Adriana Yock-Corrales[SUP] 5 [/SUP], Nipam P Shah[SUP] 6 [/SUP], Kristen A Breslin[SUP] 7 [/SUP], Pradip P Chaudhari[SUP] 8 [/SUP], Kelly R Bergmann[SUP] 9 [/SUP], Fahd A Ahmad[SUP] 10 [/SUP], Jasmine R Nebhrajani[SUP] 11 [/SUP], Santiago Mintegi[SUP] 12 [/SUP], Iker Gangoiti[SUP] 12 [/SUP], Amy C Plint[SUP] 13 [/SUP], Usha R Avva[SUP] 14 [/SUP], Michael A Gardiner[SUP] 15 [/SUP], Richard Malley[SUP] 16 [/SUP], Yaron Finkelstein[SUP] 17 [/SUP], Stuart R Dalziel[SUP] 18 [/SUP], Maala Bhatt[SUP] 19 [/SUP], Nirupama Kannikeswaran[SUP] 20 [/SUP], Kerry Caperell[SUP] 21 [/SUP], Carmen Campos[SUP] 22 [/SUP], Vikram J Sabhaney[SUP] 23 [/SUP], Shu-Ling Chong[SUP] 24 [/SUP], Maren M Lunoe[SUP] 25 [/SUP], Alexander J Rogers[SUP] 26 [/SUP], Sarah M Becker[SUP] 27 [/SUP], Meredith L Borland[SUP] 28 [/SUP], Laura F Sartori[SUP] 29 [/SUP], Viviana Pavlicich[SUP] 30 [/SUP], Pedro B Rino[SUP] 31 [/SUP], Andrea K Morrison[SUP] 32 [/SUP], Mark I Neuman[SUP] 16 [/SUP], Naveen Poonai[SUP] 33 [/SUP], Norma-Jean E Simon[SUP] 34 [/SUP], April J Kam[SUP] 35 [/SUP], Maria Y Kwok[SUP] 36 [/SUP], Claudia R Morris[SUP] 37 [/SUP], Laura Palumbo[SUP] 38 [/SUP], Lilliam Ambroggio[SUP] 39 [/SUP], Nidhya Navanandan[SUP] 39 [/SUP], Michelle Eckerle[SUP] 40 [/SUP], Terry P Klassen[SUP] 41 [/SUP], Daniel C Payne[SUP] 42 [/SUP], Jonathan C Cherry[SUP] 43 [/SUP], Muhammad Waseem[SUP] 44 [/SUP], Andrew C Dixon[SUP] 45 [/SUP], Isabel Beneyto Ferre[SUP] 46 [/SUP], Stephen B Freedman[SUP] 1 [/SUP]
Affiliations
- PMID: 37869403
- PMCID: PMC10588618
- DOI: 10.1093/ofid/ofad485
Background: To assist clinicians with identifying children at risk of severe outcomes, we assessed the association between laboratory findings and severe outcomes among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children and determined if SARS-CoV-2 test result status modified the associations.
Methods: We conducted a cross-sectional analysis of participants tested for SARS-CoV-2 infection in 41 pediatric emergency departments in 10 countries. Participants were hospitalized, had laboratory testing performed, and completed 14-day follow-up. The primary objective was to assess the associations between laboratory findings and severe outcomes. The secondary objective was to determine if the SARS-CoV-2 test result modified the associations.
Results: We included 1817 participants; 522 (28.7%) SARS-CoV-2 test-positive and 1295 (71.3%) test-negative. Seventy-five (14.4%) test-positive and 174 (13.4%) test-negative children experienced severe outcomes. In regression analysis, we found that among SARS-CoV-2-positive children, procalcitonin ≥0.5 ng/mL (adjusted odds ratio [aOR], 9.14; 95% CI, 2.90-28.80), ferritin >500 ng/mL (aOR, 7.95; 95% CI, 1.89-33.44), D-dimer ≥1500 ng/mL (aOR, 4.57; 95% CI, 1.12-18.68), serum glucose ≥120 mg/dL (aOR, 2.01; 95% CI, 1.06-3.81), lymphocyte count <1.0 × 10[SUP]9[/SUP]/L (aOR, 3.21; 95% CI, 1.34-7.69), and platelet count <150 × 10[SUP]9[/SUP]/L (aOR, 2.82; 95% CI, 1.31-6.07) were associated with severe outcomes. Evaluation of the interaction term revealed that a positive SARS-CoV-2 result increased the associations with severe outcomes for elevated procalcitonin, C-reactive protein (CRP), D-dimer, and for reduced lymphocyte and platelet counts.
Conclusions: Specific laboratory parameters are associated with severe outcomes in SARS-CoV-2-infected children, and elevated serum procalcitonin, CRP, and D-dimer and low absolute lymphocyte and platelet counts were more strongly associated with severe outcomes in children testing positive compared with those testing negative.
Keywords: C-reactive protein; COVID-19; SARS-CoV-2; child; lymphopenia; procalcitonin.