Predictors of disease severity and outcomes in pediatric patients with croup and COVID-19 in the pediatric emergency department

Complete Blood Count in Children With COVID-19: A Predictor of Disease Severity

Blood count abnormalities are frequent in patients with severe COVID-19 disease and there is still a lack of information in pediatric complete blood count (CBC) results. Thus, this study aims to correlate the CBC in the emergency room of children with COVID-19 between 0 and 10 years old and the clinical severity of the disease. A retrospective cohort study was performed in children with COVID-19 who collected at the emergency room CBC, C-reactive protein (CRP), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), neutrophil to monocyte ratio (NMR), lymphocyte to neutrophil ratio (LNR), lymphocyte to monocyte ratio (LMR), monocyte to neutrophil ratio (MNR) and monocyte to lymphocyte ratio (MLR). In total, demographic data from 93 children with median age of 19 months (0.3-126), 60.2% males, were included. The main changes in the CBC were atypical lymphocytes (51.6%) and eosinopenia (49.5%). From 69 hospitalized children, 21 were considered severe. There was no association between age, gender, and CRP value with clinical severity. The presence of underlying disease was five times higher (odds ratio [OR] = 5.08) in patients who required hospitalization and a higher NLR value was 54% (OR = 1.54) more likely to occur. Eosinopenia was three times more frequent in inpatients with disease severity criteria (OR = 3.05). In conclusion, children younger than 10 years of age with COVID-19 have changes in the CBC collected in the emergency room, mainly atypical lymphocytes and eosinopenia. The presence of a comorbidity or a higher NLR increases the chance of hospitalization. In addition, eosinopenia was a predictor of severity in inpatient children due to COVID-19.

Clinical and Paraclinical Peculiarities of SARS-CoV-2 and Influenza Infections in Children: A Comparative Study

BACKGROUND

SARS-CoV-2 and influenza can present with similar clinical pictures in children, with symptoms and paraclinical particularities which might aid in the differentiation of the two entities and which can be suggestive of various complications. The present study aims to identify clinical and paraclinical differences between pediatric SARS-CoV-2 and influenza infection and to assess the utility of hematological parameters for prediction of their related complications.

METHODS

In this study, 266 children were retrospectively enrolled, divided into two groups: 129 children diagnosed with SARS-CoV-2 infection and 137 children infected with influenza. In each case, particular symptoms were recorded, as well as hospitalization duration, pediatric intensive care unit (PICU) admission or O2 supplementation requirement. Parameters of the hemoleucogram and biochemistry parameters were also collected for comparative assessment.

RESULTS

SARS-CoV-2 infections were more commonly associated with digestive symptoms, whereas influenza infections implied longer hospital stays and higher likelihood of PICU admission necessity. Monocytes and lymphocyte/monocyte ratios (LMRs) were significantly higher in the SARS-CoV-2 group (p < 0.01, p = 0.02). Several hematological parameters, such as neutrophil/lymphocyte ratios, correlated with hospitalization duration in SARS-CoV-2 and influenza B infections (p < 0.01, p = 0.01), whereas LMR was predictive of respiratory distress (p = 0.02) in the same study groups.

CONCLUSIONS

According to the study, monocyte levels and LMR can aid in the distinction of pediatric SARS-CoV-2 and influenza infections and LMR and NLR can be used particularly as predictors of complicated course of these infections.