Coagulation profile in hospitalized children with COVID-19: pediatric age dependency and its impact on long COVID development

Introduction

Pulmonary endotheliopathy and microvascular immunothrombosis play a key role in acute COVID-19. Moreover, persistent endotheliopathy and heightened coagulability frequently occur in individuals recovering from COVID-19, suggesting the intriguing possibility of their role in the development of long COVID. The aim of our study was to investigate the coagulation profile in patients with COVID-19 based on age and their role in the development of long COVID.

Methods

We conducted a prospective single-center cohort study from September 2022 to August 2023. The study involved 190 patients younger than 18 years who were hospitalized at the Ternopil City Children's Hospital, Ukraine due to COVID-19. Patients underwent determination of coagulation profile in addition to the general clinical examination. After discharge from the hospital, patients were monitored for the presence of long COVID symptoms. Among the 157 participants who consented for follow-up, 62 patients (39.5%) had long COVID symptoms according to the WHO definition, while the rest (95 patients) did not have symptoms of long COVID (fully recovered).

Results

The study revealed the normal count of platelets in the majority of patients (86.8%), whereas abnormalities in the coagulation profile were revealed in 94.5% of children with COVID-19, and these changes were age-dependent. The patients were mostly presented with increased activated partial thromboplastin time (69.1%), prothrombin time (PT) (39.8%) and D-dimer (45.0%). There was no significant difference between the median of platelet levels and coagulation profile indicators between the groups with long COVID and recovered. Among children who developed persistent long COVID symptoms there was a statistically higher percentage of abnormal PT values (53% versus 36.1%, p=0.0432), with no significant differences in other coagulation profile indicators. Abnormal PT along with female gender, comorbidities, especially allergic pathology, nutritional disorder, including obesity, were determined as potential risk factors of the long COVID development (Odds ratio - 2.0611; 95% 1.0179-4.1737, p=0.0445).

Conclusions

The study highlights the need for more extensive research into the coagulation profiles of pediatric populations, considering age-specific factors. This could enhance our understanding of thromboinflammation in COVID-19 and its potential contribution to the development of persistent symptoms.

AWARENESS OF PRIMARY IMMUNODEFICIENCY DISEASES AMONG MEDICAL STUDENTS

Primary immunodeficiency diseases (PID) are a group of more than 300 rare, chronic disorders in which a part of the body's immune system is missing or functions improperly. The issue of early diagnosis, timely and effective treatment, prevention of complications and improved prognosis remains extremely relevant. The aim of this study was to assess the awareness of graduating medical university students about the signs of primary immunodeficiency in children and adults. A survey on awareness of primary immunodeficiencies was conducted among sixth year (graduating) students of the Faculty of Medicine of I.Horbachevsky Ternopil State Medical University, Ukraine. Questionnaires were offered to 271 students. The questionnaire consisted of 25 questions. The average percentage of correct answers given by the surveyed students for each question was 59.2% (ranging from 22.5% to 82.3%). The percentage of correct answers to the questions about warning signs of PID in children was 64.4%, and in adults was 54.2% (p=0.0491). The percentage of correct answers to the questions about general signs of PID was 61.6% and about specific signs of PID 51.7% (p=0.0016). The percentages of correct answers among surveyed students ranged from 26 to 88%. 223 (82.3%) medical students gave more than 50% of correct answers to all questions, but only 21 surveyed students (7.7%) gave more than 75% of correct answers. This study has revealed the lack of awareness for PID among medical students. The lowest knowledge was about PID warning signs in adults and the specific signs of PID, especially those concerning verification and management of Nijmegan breakage syndrome and common variable immunodeficiency. This study indicates a significant need to increase knowledge of medical students about primary immunodeficiencies, taking into account low levels of diagnosis of these diseases in Ukraine and the need to raise knowledge and awareness about PID among physicians of all specialties.