Saleh Mahasen, Alkofide Amani, Alshammari Anfal, Siddiqui Khawar, Owaidah Tarek
Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, 11533, Kingdom of Saudi Arabia.
Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Kingdom of Saudi Arabia.
J Blood Med. 2021 Sep 4;12:819-826. doi: 10.2147/JBM.S321372. eCollection 2021.
COVID-19 wreaked havoc on the healthcare system, with more than 36 million cases reported globally. Although the pediatric population makes up a lesser proportion of total COVID-19 patients than adults, the clinical status, age and comorbidities warrant identifying possible prognostic factors associated with disease severity in this group. The current study aimed to explore the incidence of thrombosis, overall outcome, and different hematological and coagulation markers in children with COVID-19.
This is a single-center prospective study of 43 patients (age < 14 years) with confirmed COVID-19 diagnosis recruited from April to August 2020. Data for clinical presentation were collected and analyzed. The samples were tested for different hematological and coagulation markers.
Twenty-nine (67.4%) were symptomatic at presentation, with fever being the most common symptom (n = 23, 53.5%), followed by respiratory (n = 5, 11.6%) and gastrointestinal symptoms (n = 3, 7%). Co-morbid conditions were recorded in 26 (60.5%) patients, with malignancy being the commonest (n = 9, 20.9%). In this cohort of patients with age <14 years, hypertension, respiratory symptoms and ABO group-A were significantly associated with pediatric intensive care unit (PICU) admission during the course of treatment. Patients with elevated FVIII and fibrinogen levels at presentation were more likely to have an extended length of hospital stay (LOS) (-value =0.036 and 0.032 respectively). No thrombotic event was observed in our cohort. D-dimer values were higher (above 0.5 µg/mL) in 24 (55.8%) patients at admission. We found an association between high D-dimer and PICU admission and LOS.
Although we did not observe thrombosis in our cohort, serial measurements of D-dimer and elevated FVIII bear a prognostic value in predicting the need for critical care in children with COVID-19. Further studies with larger sample size can aid in the establishment of prognostic factors for the pediatric COVID-19 population.
新型冠状病毒肺炎（COVID-19）给医疗系统造成了严重破坏，全球报告的病例超过3600万例。尽管儿童在COVID-19患者总数中所占比例低于成人，但临床状况、年龄和合并症使得有必要确定该群体中与疾病严重程度相关的可能预后因素。本研究旨在探讨COVID-19患儿血栓形成的发生率、总体预后以及不同的血液学和凝血指标。
这是一项单中心前瞻性研究，研究对象为2020年4月至8月招募的43例确诊为COVID-19的患者（年龄<14岁）。收集并分析临床表现数据。对样本进行不同血液学和凝血指标检测。
29例（67.4%）患者就诊时有症状，发热是最常见症状（n = 23，53.5%），其次是呼吸道症状（n = 5，11.6%）和胃肠道症状（n = 3，7%）。26例（60.5%）患者有合并症，其中恶性肿瘤最为常见（n = 9，20.9%）。在这个年龄<14岁的患者队列中，高血压、呼吸道症状和A型血型与治疗期间入住儿科重症监护病房（PICU）显著相关。就诊时FVIII和纤维蛋白原水平升高的患者住院时间（LOS）延长的可能性更大（P值分别为0.036和0.032）。我们的队列中未观察到血栓形成事件。24例（55.8%）患者入院时D-二聚体值较高（高于0.5μg/mL）。我们发现高D-二聚体与入住PICU及住院时间之间存在关联。
尽管我们的队列中未观察到血栓形成，但D-二聚体的连续测量和FVIII升高对预测COVID-19患儿的重症监护需求具有预后价值。更大样本量的进一步研究有助于确定儿童COVID-19人群的预后因素。
