Evaluation of hematological parameters and inflammatory markers in children with COVID-19.
COVID-19
Children
Hematological parameters
Hospitalization
Inflammatory markers
Journal
Irish journal of medical science
ISSN: 1863-4362
Titre abrégé: Ir J Med Sci
Pays: Ireland
ID NLM: 7806864
Informations de publication
Date de publication:
Aug 2022
Aug 2022
Historique:
received:
27
06
2021
accepted:
25
08
2021
pubmed:
17
9
2021
medline:
27
7
2022
entrez:
16
9
2021
Statut:
ppublish
Résumé
The aim of this study was to evaluate hematological parameters in children with COVID-19 and determine the effects of inflammatory biomarkers on the assessment of hospitalization. This retrospective single-center study was performed on 633 children with COVID-19 between March 2020 and January 2021. The study population was separated into two groups: inpatients (n = 83) and outpatients (n = 550). Univariate and multivariate logistic regression was applied to identify risk factors for hospitalization. Lymphopenia (n = 228, 36%) was found mainly to be a hematological abnormality in all cases. Compared with outpatients, inpatients had significantly higher white blood cell (WBC) (p = 0.005), lymphocyte (p < 0.001), and platelet counts (p = 0.036), and significantly higher red cell distribution width (p = 0.001), C-reactive protein (CRP) (p = 0.003), procalcitonin (p = 0.001), D-dimer (p < 0.001), and lymphocyte to monocyte ratio values (p = 0.004). On the other hand, they had significantly lower values of hemoglobin (p < 0.001), neutrophil to lymphocyte ratio (p = 0.024), platelet lymphocyte ratio (p = 0.001), derivated neutrophil to lymphocyte ratio (p = 0.037), and mean platelet volume to lymphocyte ratio (p < 0.001). ROC analysis showed that WBC, CRP, and procalcitonin cutoff values were the best discriminated between inpatients and outpatients. The results for the areas under the curve of WBC, CRP, and procalcitonin used to assess patients' hospitalization were 0.595 (95% CI 0.519-0.670, p = 0.005), 0.599 (95% CI 0.527-0.672, p = 0.003), and 0.599 (95% CI 0.525-0.673, p = 0.004), respectively. We suggest that high WBC and procalcitonin levels can be used as independent predictors of hospitalization in children with COVID-19.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of this study was to evaluate hematological parameters in children with COVID-19 and determine the effects of inflammatory biomarkers on the assessment of hospitalization.
METHODS
METHODS
This retrospective single-center study was performed on 633 children with COVID-19 between March 2020 and January 2021. The study population was separated into two groups: inpatients (n = 83) and outpatients (n = 550). Univariate and multivariate logistic regression was applied to identify risk factors for hospitalization.
RESULTS
RESULTS
Lymphopenia (n = 228, 36%) was found mainly to be a hematological abnormality in all cases. Compared with outpatients, inpatients had significantly higher white blood cell (WBC) (p = 0.005), lymphocyte (p < 0.001), and platelet counts (p = 0.036), and significantly higher red cell distribution width (p = 0.001), C-reactive protein (CRP) (p = 0.003), procalcitonin (p = 0.001), D-dimer (p < 0.001), and lymphocyte to monocyte ratio values (p = 0.004). On the other hand, they had significantly lower values of hemoglobin (p < 0.001), neutrophil to lymphocyte ratio (p = 0.024), platelet lymphocyte ratio (p = 0.001), derivated neutrophil to lymphocyte ratio (p = 0.037), and mean platelet volume to lymphocyte ratio (p < 0.001). ROC analysis showed that WBC, CRP, and procalcitonin cutoff values were the best discriminated between inpatients and outpatients. The results for the areas under the curve of WBC, CRP, and procalcitonin used to assess patients' hospitalization were 0.595 (95% CI 0.519-0.670, p = 0.005), 0.599 (95% CI 0.527-0.672, p = 0.003), and 0.599 (95% CI 0.525-0.673, p = 0.004), respectively.
CONCLUSION
CONCLUSIONS
We suggest that high WBC and procalcitonin levels can be used as independent predictors of hospitalization in children with COVID-19.
Identifiants
pubmed: 34529237
doi: 10.1007/s11845-021-02762-5
pii: 10.1007/s11845-021-02762-5
pmc: PMC8443907
doi:
Substances chimiques
Biomarkers
0
Procalcitonin
0
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1725-1733Informations de copyright
© 2021. Royal Academy of Medicine in Ireland.
Références
Ladhani SN, Amin-Chowdhury Z, Davies HG et al (2020) COVID-19 in children: analysis of the first pandemic peak in England. Arch Dis Child. https://doi.org/10.1136/archdischild-2020-320042
doi: 10.1136/archdischild-2020-320042
pubmed: 33177053
Coronavirus Disease 2019 (COVID-19) Treatment Guidelines (2021). National Institutes of Health (US). https://www.covid19treatmentguidelines.nih.gov . Accessed 21 April 2021
Kosmeri C, Koumpis E, Tsabouri S et al (2020) Hematological manifestations of SARS-CoV-2 in children. Pediatr Blood Cancer 67(12):e28745
doi: 10.1002/pbc.28745
Kermali M, Khalsa RK, Pillai K et al (2020) The role of biomarkers in diagnosis of COVID-19—a systematic review. Life Sci. https://doi.org/10.1016/j.lfs.2020.117788
doi: 10.1016/j.lfs.2020.117788
pubmed: 32475810
pmcid: 7219356
Pourbagheri-Sigaroodi A, Bashash D, Fateh F, Abolghasemi H (2020) Laboratory findings in COVID-19 diagnosis and prognosis. Clin Chim Acta 510:475–482
doi: 10.1016/j.cca.2020.08.019
Xue G, Gan X, Wu Z et al (2020) Novel serological biomarkers for inflammation in predicting disease severity in patients with COVID-19. Int Immunopharmacol. https://doi.org/10.1016/j.intimp.2020.107065
doi: 10.1016/j.intimp.2020.107065
pubmed: 33401205
pmcid: 7759121
Walkovich KL, Newburger PE (2016). Leukopenia In: Kliegman RM, Stanton BF, St Geme JW, III, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 20th ed International Edition: Elsevier, pp 1047–1055
Karbuz A, Akkoc G, Bedir Demirdag T et al (2021) Epidemiological, clinical, and laboratory features of children with COVID-19 in Turkey. Front Pediatr. https://doi.org/10.3389/fped.2021.631547
doi: 10.3389/fped.2021.631547
pubmed: 34055680
pmcid: 8161543
Lippi G, Plebani M (2020) Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med 58:1131–1134
doi: 10.1515/cclm-2020-0198
Zhu Y, Cao X, Tao G et al (2013) The lymph index: a potential hematological parameter for viral infection. Int J Infect Dis. https://doi.org/10.1016/j.ijid.2012.12.002
doi: 10.1016/j.ijid.2012.12.002
pubmed: 24333640
Terpos E, Ntanasis-Stathopoulos I, Elalamy I et al (2020) Hematological findings and complications of COVID-19. Am J Hematol 95:834–847
doi: 10.1002/ajh.25829
Castagnoli R, Votto M, Licari A et al (2020) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review. JAMA Pediatr 174:882–889
doi: 10.1001/jamapediatrics.2020.1467
Xu H, Liu E, Xie J et al (2020) A follow-up study of children infected with SARS-CoV-2 from western China. Ann Transl Med 8:623–623. https://doi.org/10.21037/atm-20-3192
doi: 10.21037/atm-20-3192
pubmed: 32566560
pmcid: 7290618
Yarali N, Akcabelen YM, Unal Y, Parlakay AN (2021) Hematological parameters and peripheral blood morphologic abnormalities in children with COVID-19. Pediatr Blood Cancer 68:e28596
doi: 10.1002/pbc.28596
Guner Ozenen G, Sahbudak Bal Z, Umit Z et al (2021) Demographic, clinical, and laboratory features of COVID-19 in children: the role of mean platelet volume in predicting hospitalization and severity. J Med Virol 93:3227–3237. https://doi.org/10.1002/jmv.26902
doi: 10.1002/jmv.26902
pubmed: 33629365
pmcid: 8013348
Yan X, Li F, Wang X et al (2020) Neutrophil to lymphocyte ratio as prognostic and predictive factor in patients with coronavirus disease 2019: a retrospective cross-sectional study. J Med Virol 92:2573–2581. https://doi.org/10.1002/jmv.2606
doi: 10.1002/jmv.2606
pubmed: 32458459
pmcid: 7283791
Asghar MS, Khan NA, Haider Kazmi SJ et al (2020) Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comparative analysis. J Community Hosp Intern Med Perspect 10:514–520. https://doi.org/10.1080/20009666.2020.1816276
doi: 10.1080/20009666.2020.1816276
pubmed: 33194120
pmcid: 7599007
Djordjevic D, Rondovic G, Surbatovic M et al (2018) Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume-to-platelet count ratio as biomarkers in critically Ill and ınjured patients: which ratio to choose to predict outcome and nature of bacteremia? Mediat Inflamm. https://doi.org/10.1155/2018/3758068
doi: 10.1155/2018/3758068
Lee JS, Kim NY, Na SH et al (2018) Reference values of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, and mean platelet volume in healthy adults in South Korea. Medicine (United States). https://doi.org/10.1097/MD.0000000000011138
doi: 10.1097/MD.0000000000011138
pubmed: 30940363
pmcid: 6323551
Gong S, Gao X, Xu F et al (2018) Association of lymphocyte to monocyte ratio with severity of coronary artery disease. Medicine (United States). https://doi.org/10.1097/MD.0000000000012813
doi: 10.1097/MD.0000000000012813
pubmed: 30323337
pmcid: 6358437
Yang AP, Liu JP, Tao WQ, Li HM (2020) The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. https://doi.org/10.1016/j.intimp.2020.106504
doi: 10.1016/j.intimp.2020.106504
pubmed: 33373810
pmcid: 7724312
Kalabin A, Mani VRK, Valdivieso SC, Donaldson B (2021) Role of neutrophil-to-lymphocyte, lymphocyte-to-monocyte and platelet-to-lymphocyte ratios as predictors of disease severity in COVID-19 patients. Infez Med 29:46–53
pubmed: 33664172
Rizo-Téllez SA, Méndez-García LA, Flores-Rebollo C et al (2020) The neutrophil-to-monocyte ratio and lymphocyte-to-neutrophil ratio at admission predict in-hospital mortality in mexican patients with severe SARS-CoV-2 infection (COVID-19). Microorganisms 8:1–17. https://doi.org/10.3390/microorganisms8101560
doi: 10.3390/microorganisms8101560
Wang H, Xing Y, Yao X et al (2020) Retrospective study of clinical features of COVID-19 in inpatients and their association with disease severity. Med Sci Monit. https://doi.org/10.12659/MSM.927674
doi: 10.12659/MSM.927674
pubmed: 33378324
pmcid: 7781048
Lagunas-Rangel FA (2020) Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. J Med Virol 92:1733–1734
doi: 10.1002/jmv.25819
Mousavi SA, Rad S, Rostami T et al (2020) Hematologic predictors of mortality in hospitalized patients with COVID-19: a comparative study. Hematol (United Kingdom) 25:383–388. https://doi.org/10.1080/16078454.2020.1833435
doi: 10.1080/16078454.2020.1833435
Fois AG, Paliogiannis P, Scano V et al (2020) The systemic inflammation index on admission predicts in-hospital mortality in COVID-19 patients. Molecules. https://doi.org/10.3390/molecules25235725
doi: 10.3390/molecules25235725
pubmed: 33291581
pmcid: 7731255
Bommenahalli Gowda S, Gosavi S, Ananda Rao A et al (2021) Prognosis of COVID-19: red cell distribution width, platelet distribution width, and C-reactive protein. Cureus. https://doi.org/10.7759/cureus.13078
doi: 10.7759/cureus.13078
pubmed: 33680618
pmcid: 7932824
Lippi G, Plebani M (2020) Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chim Acta 505:190–191
doi: 10.1016/j.cca.2020.03.004