Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Blood. 2021 Jul 15;138(2):190-198. doi: 10.1182/blood.2020010218.
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with thrombotic complications in adults, but the incidence of COVID-19-related thrombosis in children and adolescents is unclear. Most children with acute COVID-19 have mild disease, but coagulopathy has been associated with multisystem inflammatory syndrome in children (MIS-C), a postinfectious complication. We conducted a multicenter retrospective cohort study to determine the incidence of thrombosis in children hospitalized with COVID-19 or MIS-C and evaluate associated risk factors. We classified patients into 1 of 3 groups for analysis: COVID-19, MIS-C, or asymptomatic SARS-CoV-2. Among a total of 853 admissions (COVID-19, n = 426; MIS-C, n = 138; and asymptomatic SARS-CoV-2, n = 289) in 814 patients, there were 20 patients with thrombotic events (TEs; including 1 stroke). Patients with MIS-C had the highest incidence (9 [6.5%] of 138) vs COVID-19 (9 [2.1%] of 426) or asymptomatic SARS-CoV-2 (2 [0.7%] of 289). In patients with COVID-19 or MIS-C, a majority of TEs (89%) occurred in patients age ≥12 years. Patients age ≥12 years with MIS-C had the highest rate of thrombosis at 19% (9 of 48). Notably, 71% of TEs that were not present on admission occurred despite thromboprophylaxis. Multivariable analysis identified the following as significantly associated with thrombosis: age ≥12 years, cancer, presence of a central venous catheter, and MIS-C. In patients with COVID-19 or MIS-C, hospital mortality was 2.3% (13 of 564), but it was 28% (5 of 18) in patients with TEs. Our findings may help inform pediatric thromboprophylaxis strategies.
新型冠状病毒病 2019（COVID-19）由严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）引起，与成年人的血栓并发症有关，但儿童和青少年 COVID-19 相关血栓的发病率尚不清楚。大多数急性 COVID-19 的儿童病情较轻，但凝血功能障碍与儿童多系统炎症综合征（MIS-C）有关，这是一种感染后并发症。我们进行了一项多中心回顾性队列研究，以确定住院 COVID-19 或 MIS-C 患儿的血栓形成发生率，并评估相关的危险因素。我们将患者分为以下 3 组进行分析：COVID-19、MIS-C 或无症状 SARS-CoV-2。在总共 814 名患者的 853 例住院治疗中（COVID-19 患者 426 例，MIS-C 患者 138 例，无症状 SARS-CoV-2 患者 289 例），有 20 例患者发生血栓事件（TEs；包括 1 例中风）。MIS-C 患者的发病率最高（138 例中的 9 例，6.5%），其次是 COVID-19（426 例中的 9 例，2.1%）或无症状 SARS-CoV-2（289 例中的 2 例，0.7%）。在 COVID-19 或 MIS-C 患者中，大多数 TEs（89%）发生在年龄≥12 岁的患者中。年龄≥12 岁的 MIS-C 患者血栓形成率最高，为 19%（48 例中的 9 例）。值得注意的是，尽管进行了血栓预防，但仍有 71%的 TEs 在入院时并未出现。多变量分析发现，年龄≥12 岁、癌症、存在中心静脉导管和 MIS-C 与血栓形成显著相关。COVID-19 或 MIS-C 患者的住院死亡率为 2.3%（564 例中的 13 例），但 TEs 患者的死亡率为 28%（18 例中的 5 例）。我们的研究结果可能有助于为儿科血栓预防策略提供信息。
