Department of Respiratory, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Institute of Maternal and Child Health, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Pediatr Infect Dis J. 2020 Jul;39(7):e91-e94. doi: 10.1097/INF.0000000000002739.
Novel coronavirus disease (COVID-19) is spreading globally. Little is known about the risk factors for the clinical outcomes of COVID-19 in children.
A retrospective case-control study was taken in children with severe acute respiratory syndrome coronary virus-2 infection in Wuhan Children's Hospital. Risk factors associated with the development of COVID-19 and progression were collected and analyzed.
Eight of 260 children diagnosed with severe COVID-19 pneumonia were included in the study. Thirty-five children with COVID-19 infection matched for age, sex and date of admission, and who classified as non-severe type, were randomly selected from the hospital admissions. For cases with severe pneumonia caused by COVID-19, the most common symptoms were dyspnea (87.5%), fever (62.5%) and cough (62.5%). In laboratory, white blood cells count was significantly higher in severe children than non-severe children. Levels of inflammation bio-makers such as hsCRP, IL-6, IL-10 and D-dimer elevated in severe children compared with non-severe children on admission. The level of total bilirubin and uric acid clearly elevated in severe children compared with non-severe children on admission. All of severe children displayed the lesions on chest CT, more lung segments were involved in severe children than in non-severe children, which was only risk factor associated with severe COVID-19 pneumonia in multivariable analysis.
More than 3 lung segments involved were associated with greater risk of development of severe COVID-19 in children. Moreover, the possible risk of the elevation of IL-6, high total bilirubin and D-dimer with univariable analysis could identify patients to be severe earlier.
新型冠状病毒病（COVID-19）正在全球范围内传播。关于 COVID-19 儿童临床结局的危险因素知之甚少。
本研究采用回顾性病例对照研究，纳入武汉儿童医院 260 例严重急性呼吸综合征冠状病毒 2 感染患儿。收集并分析与 COVID-19 发展和进展相关的危险因素。
在 260 例诊断为严重 COVID-19 肺炎的患儿中，纳入 8 例研究对象。从医院住院患儿中随机选择 35 例年龄、性别和入院日期匹配的 COVID-19 感染患儿，分类为非重症型。对于由 COVID-19 引起的严重肺炎病例，最常见的症状是呼吸困难（87.5%）、发热（62.5%）和咳嗽（62.5%）。在实验室检查中，重症患儿的白细胞计数明显高于轻症患儿。与轻症患儿相比，重症患儿入院时炎症生物标志物如 hsCRP、IL-6、IL-10 和 D-二聚体水平升高。与轻症患儿相比，重症患儿入院时总胆红素和尿酸水平明显升高。所有重症患儿均在胸部 CT 上显示病变，重症患儿受累的肺段数多于轻症患儿，这是多变量分析中与严重 COVID-19 肺炎相关的唯一危险因素。
累及 3 个以上肺段与儿童发生严重 COVID-19 的风险增加相关。此外，单变量分析中 IL-6、总胆红素和 D-二聚体升高的可能风险可能更早识别出重症患者。
