Department of Pediatrics, Section of Infectious Diseases, Medical College of Wisconsin, Milwaukee, WI, USA.
, PO Box 1997, Suite C450 Pediatric Infectious Diseases, Milwaukee, WI, USA.
BMC Infect Dis. 2024 Sep 17;24(1):987. doi: 10.1186/s12879-024-09833-9.
Transaminase and creatinine elevations have been well described in adults treated with remdesivir for COVID-19. It is hypothesized that a similar safety profile exists in children with COVID-19 treated with remdesivir, but available data are limited, especially in children < 12 months. The primary aim of this study was to determine the prevalence and timing of elevations in transaminases and creatinine in children with COVID-19 who were treated with remdesivir.
This was a retrospective, observational cohort study including all pediatric patients admitted to a single, freestanding children's hospital who were positive for COVID-19 and received at least 1 dose of remdesivir between 1/1/2020 and 5/31/2022. Available baseline and peak transaminase and creatinine concentrations were evaluated. Multivariable logistic regression analysis was performed to identify risk factors for transaminase elevation.
A total of 180 patients met inclusion criteria. Creatinine elevation of any grade was noted in 16% and remained elevated only in those with underlying chronic kidney disease. Transaminase elevation of any grade was noted in 58% of patients and remained elevated in only 1%. Older age and critical respiratory disease were associated with higher risk of significant transaminase elevation, whereas non-Hispanic ethnicity was strongly associated with protection against significant transaminase elevation.
In our cohort of hospitalized children with COVID-19 who were treated with remdesivir, most patients experienced only mild transaminitis and normal creatinine concentrations. A limited number of patients experienced laboratory abnormalities which were transient, suggesting a favorable safety profile for remdesivir use in pediatrics.
接受瑞德西韦治疗 COVID-19 的成年人的转氨酶和肌酐升高已得到充分描述。据推测，接受瑞德西韦治疗的 COVID-19 儿童也存在类似的安全性特征，但现有数据有限，尤其是在<12 个月的儿童中。本研究的主要目的是确定接受瑞德西韦治疗的 COVID-19 儿童中转氨酶和肌酐升高的发生率和时间。
这是一项回顾性观察队列研究，纳入了 2020 年 1 月 1 日至 2022 年 5 月 31 日期间在一家独立的儿童医院住院且 COVID-19 检测阳性并至少接受一剂瑞德西韦治疗的所有儿科患者。评估了可用的基线和峰值转氨酶和肌酐浓度。采用多变量逻辑回归分析来确定转氨酶升高的危险因素。
共纳入 180 例患者符合纳入标准。任何等级的肌酐升高的发生率为 16%，仅在有基础慢性肾脏病的患者中持续升高。任何等级的转氨酶升高的发生率为 58%，仅在 1%的患者中持续升高。年龄较大和严重呼吸疾病与较高的显著转氨酶升高风险相关，而非西班牙裔种族与显著转氨酶升高的保护作用相关。
在我们接受瑞德西韦治疗的 COVID-19 住院儿童队列中，大多数患者仅经历轻微的肝酶升高和正常的肌酐浓度。少数患者出现短暂的实验室异常，表明瑞德西韦在儿科使用的安全性良好。
