Eldin Nashwa M B, Saleh Maysa, Labib Bahaaeldin, Othman Marwa, Chacko Lalu, Mae Daphne, Elnour Lamiaa, Al-Rifai Rami H
Department of Pediatric, Burjeel Hospital, Abu Dhabi, United Arab Emirates.
Pediatric Department, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates.
Front Pediatr. 2022 Mar 15;10:830587. doi: 10.3389/fped.2022.830587. eCollection 2022.
This study investigated clinical and laboratory differences between confirmed (RT-PCR-positive) and clinically suspected (RT-PCR-negative) COVID-19 pediatric patients, and explored factors associated with disease severity at presentation and duration of hospitalization.
Medical charts of COVID-19-confirmed and clinically suspected pediatric patients admitted to a tertiary hospital in Abu Dhabi were reviewed. Sociodemographic information and clinical and laboratory outcomes were retrieved and analyzed.
Between 1 April to 30 June, 2020, 173 patients (mean age: 3.6 ± SD 3.2 years) presented with respiratory symptoms. Of them, 18.0% had confirmed contact with COVID-19 cases, 66.5% had symptoms for ≤3 days, and 86.7% were with moderate to severe disease. Twenty-eight (16.1%) patients tested positive while the rest (83.8%) tested negative in RT-PCR. COVID-19-confirmed and clinically suspected patients were statistically similar ( > 0.05) in all sociodemographic data, disease severity, and vital signs except residence status (89.3% vs. 58.6% were residents, respectively, = 0.002) and contact with confirmed COVID-19 cases (82.1% vs. 5.5%, respectively, < 0.001). Fever (100 and 91.0%) and cough (100 and 95.9%) were the most common symptoms in both confirmed and clinically suspected COVID-19 patients. All patients were statistically comparable in mean white blood cell and platelet counts and hemoglobin concentration, except in mean concentration of neutrophils (higher in clinically suspected, = 0.019). C-reactive protein was two times higher in clinically suspected compared to confirmed patients ( = 0.043). Lymphocyte (OR: 1.31, < 0.001), LDH (OR: 1.01, = 0.001), D-dimer (OR: 1.92, < 0.001), and ferritin levels after 24-36 h (OR: 9.25, < 0.05), and SGPT (OR: 1.04, < 0.05) were all associated with disease severity. Elevated ferritin (>300 μg/L) after 24-36 h was the only correlated factor with disease severity (aOR: 17.38, < 0.05). Confirmed compared with clinically suspected patients (aOR: 4.00, 95% CI: 2.92-5.10) and children with moderate compared with mild disease (aOR: 5.87, 95% CI: 1.08-32.06) had longer hospitalization.
In pediatric patients with negative RT-PCR, COVID-19 is still suspected based on clinical symptoms and epidemiological data. A tentative diagnosis can be made based on a thorough examination, and proper medical management can be initiated promptly.
本研究调查了确诊（逆转录聚合酶链反应阳性）和临床疑似（逆转录聚合酶链反应阴性）的新型冠状病毒肺炎儿科患者的临床及实验室差异，并探讨了与疾病严重程度及住院时长相关的因素。
回顾了阿布扎比一家三级医院收治的确诊及临床疑似新型冠状病毒肺炎儿科患者的病历。收集并分析了社会人口统计学信息以及临床和实验室检查结果。
在2020年4月1日至6月30日期间，173例（平均年龄：3.6±标准差3.2岁）出现呼吸道症状的患者中，18.0%有与新型冠状病毒肺炎病例的确诊接触史，66.5%的症状持续时间≤3天，86.7%为中重度疾病。28例（16.1%）患者逆转录聚合酶链反应检测呈阳性，其余（83.8%）检测呈阴性。确诊和临床疑似患者在所有社会人口统计学数据、疾病严重程度及生命体征方面，除居住状况（分别为89.3%和58.6%为居民，P=0.002）及与确诊新型冠状病毒肺炎病例的接触情况（分别为82.1%和5.5%，P<0.001）外，差异无统计学意义（P>0.05）。发热（100%和91.0%）及咳嗽（100%和95.9%）是确诊及临床疑似新型冠状病毒肺炎患者最常见的症状。除中性粒细胞平均浓度外（临床疑似患者较高，P=0.019），所有患者的白细胞、血小板计数及血红蛋白浓度的平均值在统计学上无差异。临床疑似患者的C反应蛋白水平是确诊患者的两倍（P=0.043）。淋巴细胞（比值比：1.31，P<0.001）、乳酸脱氢酶（比值比：1.01，P=0.001）、D-二聚体（比值比：1.92，P<0.001）以及24 - 36小时后的铁蛋白水平（比值比：9.25，P<0.05）和谷丙转氨酶（比值比：1.04，P<0.05）均与疾病严重程度相关。24 - 36小时后铁蛋白升高（>300μg/L）是与疾病严重程度唯一相关的因素（校正比值比：17.38，P<0.05）。与临床疑似患者相比，确诊患者（校正比值比：4.00，95%置信区间：2.92 - 5.10）以及中重度疾病患儿与轻度疾病患儿相比（校正比值比：5.87，95%置信区间：1.08 - 32.06）住院时间更长。
对于逆转录聚合酶链反应检测阴性的儿科患者，仍需根据临床症状和流行病学数据怀疑新型冠状病毒肺炎。通过全面检查可做出初步诊断，并及时启动适当的医疗管理。
