Impact of SARS-CoV-2 Infection on the Association Between Laboratory Tests and Severe Outcomes Among Hospitalized Children-Reference-Cited by-同舟云学术

Impact of SARS-CoV-2 Infection on the Association Between Laboratory Tests and Severe Outcomes Among Hospitalized Children

Published:2023-09-30 Issue:10 Volume:10 Page:
ISSN:2328-8957
Container-title:Open Forum Infectious Diseases
language:en
Short-container-title:

Author:

Xie Jianling¹^ORCID,Kuppermann Nathan²,Florin Todd A³^ORCID,Tancredi Daniel J²,Funk Anna L¹,Kim Kelly¹,Salvadori Marina I⁴,Yock-Corrales Adriana⁵,Shah Nipam P⁶,Breslin Kristen A⁷,Chaudhari Pradip P⁸,Bergmann Kelly R⁹,Ahmad Fahd A¹⁰^ORCID,Nebhrajani Jasmine R¹¹,Mintegi Santiago¹²,Gangoiti Iker¹²,Plint Amy C¹³,Avva Usha R¹⁴,Gardiner Michael A¹⁵,Malley Richard¹⁶,Finkelstein Yaron¹⁷,Dalziel Stuart R¹⁸,Bhatt Maala¹⁹,Kannikeswaran Nirupama²⁰,Caperell Kerry²¹,Campos Carmen²²,Sabhaney Vikram J²³,Chong Shu-Ling²⁴^ORCID,Lunoe Maren M²⁵,Rogers Alexander J²⁶,Becker Sarah M²⁷,Borland Meredith L²⁸,Sartori Laura F²⁹,Pavlicich Viviana³⁰,Rino Pedro B³¹,Morrison Andrea K³²,Neuman Mark I¹⁶,Poonai Naveen³³,Simon Norma-Jean E³⁴,Kam April J³⁵^ORCID,Kwok Maria Y³⁶,Morris Claudia R³⁷,Palumbo Laura³⁸,Ambroggio Lilliam³⁹,Navanandan Nidhya³⁹,Eckerle Michelle⁴⁰,Klassen Terry P⁴¹,Payne Daniel C⁴²^ORCID,Cherry Jonathan C⁴³,Waseem Muhammad⁴⁴,Dixon Andrew C⁴⁵,Ferre Isabel Beneyto⁴⁶,Freedman Stephen B¹^ORCID

Affiliation:

1. University of Calgary , Calgary, Alberta , Canada

2. Davis School of Medicine, University of California , Sacramento, California , USA

3. Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University , Chicago, Illinois , USA

4. Public Health Agency of Canada , Ottawa, Ontario , Canada

5. Hospital Nacional de Niños ¨Dr. Carlos Sáenz Herrera”, CCSS , San José , Costa Rica

6. University of Alabama at Birmingham , Birmingham, Alabama , USA

7. Children’s National Hospital , Washington, DC , USA

8. University of Southern California , Los Angeles, California , USA

9. Children’s Minnesota , Minneapolis, Minnesota , USA

10. Washington University School of Medicine , St.Louis, Missouri , USA

11. St.Mary’s Medical Center , West Palm Beach, Florida , USA

12. University of the Basque Country, UPV/EHU Bilbao , Basque Country , Spain

13. University of Ottawa , Ottawa, Ontario , Canada

14. Montefiore-Nyack Hospital , Nyack, NewYork, New York , USA

15. University of California San Diego , San Diego, California , USA

16. Harvard Medical School , Boston, Massachusetts , USA

17. Hospital for Sick Children , Toronto, Ontario , Canada

18. University of Auckland , Auckland, Auckland , New Zealand

19. Children’s Hospital of Eastern Ontario , Ottawa, Ontario , Canada

20. Central Michigan University , Detroit, Michigan , USA

21. University of Louisville , Louisville, Kentucky , USA

22. Hospital Universitario Miguel Servet , Zaragoza , Spain

23. University of British Columbia , Vancouver, British Columbia , Canada

24. Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute , Singapore

25. UPMC Children’s Hospital of Pittsburgh , Pittsburgh, Pennsylvania , USA

26. University of Michigan School of Medicine , Ann Arbor, Michigan , USA

27. Primary Children’s Hospital, Intermountain Healthcare , Salt Lake City, Utah , USA

28. University of Western Australia , Perth, Western Australia , Australia

29. Children’s Hospital of Philadelphia , Philadelphia, Pennsylvania , USA

30. Universidad Privada del Pacífico , San Lorenzo , Paraguay

31. Hospital de Pediatría “Prof. Dr. Juan P. Garrahan,” RIDEPLA , Buenos Aires , Argentina

32. Medical College of Wisconsin , Milwaukee, Wisconsin , USA

33. Schulich School of Medicine & Dentistry , London, Ontario , Canada

34. Ann and Robert H Lurie Children’s Hospital of Chicago , Chicago, Illinois , USA

35. McMaster Children’s Hospital , Hamilton, Ontario , Canada

36. Columbia University Irving Medical Center , NewYork, New York , USA

37. Children’s Healthcare of Atlanta, Emory University School of Medicine , Atlanta, Georgia , USA

38. ASST Spedali Civili di Brescia—Pronto Soccorso Pediatrico , Brescia , Italy

39. University of Colorado , Aurora, Colorado , USA

40. University of Cincinnati College of Medicine , Cincinnati, Ohio , USA

41. University of Manitoba , Winnipeg, Manitoba , Canada

42. Centers for Disease Control and Prevention , Atlanta, Georgia , USA

43. Dalhousie University , Halifax, Nova Scotia , Canada

44. Lincoln Medical Center, Bronx NewYork , New York , USA

45. University of Alberta , Edmonton, Alberta , Canada

46. Hospital Francesc de Borja , Gandia , Spain

Abstract

Abstract Background To assist clinicians with identifying children at risk of severe outcomes, we assessed the association between laboratory findings and severe outcomes among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–infected children and determined if SARS-CoV-2 test result status modified the associations. Methods We conducted a cross-sectional analysis of participants tested for SARS-CoV-2 infection in 41 pediatric emergency departments in 10 countries. Participants were hospitalized, had laboratory testing performed, and completed 14-day follow-up. The primary objective was to assess the associations between laboratory findings and severe outcomes. The secondary objective was to determine if the SARS-CoV-2 test result modified the associations. Results We included 1817 participants; 522 (28.7%) SARS-CoV-2 test-positive and 1295 (71.3%) test-negative. Seventy-five (14.4%) test-positive and 174 (13.4%) test-negative children experienced severe outcomes. In regression analysis, we found that among SARS-CoV-2-positive children, procalcitonin ≥0.5 ng/mL (adjusted odds ratio [aOR], 9.14; 95% CI, 2.90–28.80), ferritin >500 ng/mL (aOR, 7.95; 95% CI, 1.89–33.44), D-dimer ≥1500 ng/mL (aOR, 4.57; 95% CI, 1.12–18.68), serum glucose ≥120 mg/dL (aOR, 2.01; 95% CI, 1.06–3.81), lymphocyte count <1.0 × 109/L (aOR, 3.21; 95% CI, 1.34–7.69), and platelet count <150 × 109/L (aOR, 2.82; 95% CI, 1.31–6.07) were associated with severe outcomes. Evaluation of the interaction term revealed that a positive SARS-CoV-2 result increased the associations with severe outcomes for elevated procalcitonin, C-reactive protein (CRP), D-dimer, and for reduced lymphocyte and platelet counts. Conclusions Specific laboratory parameters are associated with severe outcomes in SARS-CoV-2-infected children, and elevated serum procalcitonin, CRP, and D-dimer and low absolute lymphocyte and platelet counts were more strongly associated with severe outcomes in children testing positive compared with those testing negative.

Funder

Canadian Institutes of Health Research

Alberta Health Services

University of Calgary

Clinical Research Fund

Alberta Children's Hospital Research Institute

COVID-19 Research Accelerator Funding Track

University of California

Cincinnati Children's Hospital Medical Center

University of Calgary Eyes-High Post-Doctoral Research Fund

Alberta Children's Hospital Foundation

Cure Kids New Zealand