Baseline laboratory parameters for preliminary diagnosis of COVID-19 among children: a cross-sectional study

Dobrijević, Dejan; Katanić, Jasmina; Todorović, Maša; Vučković, Biljana

doi:10.1590/1516-3180.2021.0634.R1.05012022

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Sao Paulo Medical Journal

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Original Article • Sao Paulo Med. J. 140 (5) • Sep-Oct 2022 • https://doi.org/10.1590/1516-3180.2021.0634.R1.05012022 copy

Baseline laboratory parameters for preliminary diagnosis of COVID-19 among children: a cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND:

Clinical judgment of initial baseline laboratory tests plays an important role in triage and preliminary diagnosis among coronavirus disease 2019 (COVID-19) patients.

OBJECTIVES:

To determine the differences in laboratory parameters between COVID-19 and COVID-like patients, and between COVID-19 and healthy children. Additionally, to ascertain whether healthy children or patients with COVID-like symptoms would form a better control group.

DESIGN AND SETTING:

Cross-sectional study at the Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia.

METHODS:

A retrospective study was conducted on 42 pediatric patients of both sexes with COVID-19. Hematological parameters (white blood cell count, absolute lymphocyte count and platelet count) and biochemical parameters (natremia, kalemia, chloremia, aspartate aminotransferase [AST], alanine aminotransferase [ALT], lactate dehydrogenase [LDH] and C-reactive protein [CRP]) were collected. The first control group was formed by 80 healthy children and the second control group was formed by 55 pediatric patients with COVID-like symptoms.

RESULTS:

Leukocytosis, lymphopenia, thrombocytosis, elevated systemic inflammatory index and neutrophil-lymphocyte ratio, hyponatremia, hypochloremia and elevated levels of AST, ALT, LDH and CRP were present in COVID patients, in comparison with healthy controls, while in comparison with COVID-like controls only lymphopenia was determined.

CONCLUSIONS:

The presence of leukocytosis, lymphopenia, thrombocytosis, elevated systemic inflammatory index and neutrophil-lymphocyte ratio, hyponatremia, hypochloremia and elevated levels of AST, ALT, LDH and CRP may help healthcare providers in early identification of COVID-19 patients. Healthy controls were superior to COVID-like controls since they provided better insight into the laboratory characteristics of children with novel betacoronavirus (SARS-CoV-2) infection.

KEY WORDS (MeSH terms):
COVID-19; SARS-CoV-2; Child; Biomarkers

AUTHORS’ KEY WORDS:
Children with COVID; Laboratory diagnosis; Control group selection

Patient features		Total (n = 177)	COVID-19 group (n = 42)	Healthy controls (n = 80)	COVID-like controls (n = 55)
Gender	Female	84 (47.5%)	24 (57.1%)	33 (41.3%)	27 (49.1%)
Gender	Male	93 (52.5%)	18 (42.9%)	47 (58.7%)	28 (50.9%)
Age (years) ^*	General	5.56 ± 5.98	5.24 ± 6.04	5.84 ± 6.12	5.39 ± 5.81
	General	3.0 (0.44-11.0)	5.50 (0.25-10.0)	3.0 (0.74-11.0)	3.0 (0.44-12.0)
	Female	6.08 ± 6.29	6.12 ± 6.54	6.63 ± 6.46	5.38 ± 5.98
	Female	4.0 (0.46-12.75)	6.00 (1.25-10.0)	4.0 (0.83-13.5)	3.5 (0.54-13.0)
	Male	5.08 ± 5.68	4.07 ± 5.25	5.28 ± 5.89	5.40 ± 5.73
	Male	3.0 (0.44-10.0)	5.00 (0.23-10.0)	3.0 (0.5-10.0)	3.0 (0.43-12.0)

Characteristic	COVID-19 group (group 1)	Healthy controls (group 2)	COVID-like controls (group 3)	P value^†
Characteristic	COVID-19 group (group 1)	Healthy controls (group 2)	COVID-like controls (group 3)	1 versus 2	1 versus 3
Leukocytosis	12 (28.6%)	0	14 (26.9%)	P < 0.001	P = 0.541
Lymphopenia	7 (16.7%)	0	1 (1.9%)	P < 0.001	P = 0.025
Thrombocytosis	9 (21.4%)	2 (2.5%)	14 (26.9%)	P < 0.001	P = 0.723

Hematological indices/ratios	COVID-19 group (group 1)	Healthy controls (group 2)	COVID-like controls (group 3)	P value^†
Hematological indices/ratios	COVID-19 group (group 1)	Healthy controls (group 2)	COVID-like controls (group 3)	1 versus 2	1 versus 3
SII	1069.62	475.83	746.44	P = 0.008	P = 0.305
NLR	3.46	1.86	2.11	P = 0.007	P = 0.100
PLR	126.89	109.73	114.18	P = 0.254	P = 0.546

Biochemical parameter	COVID-19 group (group 1)	Healthy controls (group 2)	COVID-like controls (group 3)	P value^†
Biochemical parameter	COVID-19 group (group 1)	Healthy controls (group 2)	COVID-like controls (group 3)	1 versus 2	1 versus 3
Natremia (mmol/l)	136.43	141.28	135.48	P < 0.001	P = 0.211
Kalemia (mmol/l)	4.72	4.69	4.52	P = 0.785	P = 0.293
Chloremia (mmol/l)	102.15	103.83	100.42	P = 0.017	P = 0.549
AST (μkat/l)	0.94	0.47	0.88	P < 0.001	P = 0.832
ALT (μkat/l)	0.71	0.33	0.68	P = 0.002	P = 0.907
LDH (μkat/l)	5.51	3.74	4.69	P < 0.001	P = 0.155
CRP (mg/l)	38.63	1.15	53.82	P < 0.001	P = 0.280

Parameter	COVID-19 patients	Healthy controls	P value^†
CRP ≥ 2.1 mg/l	32 (76.2%)	8 (10.0%)	< 0.001
AST ≥ 0.49 μkat/l	29 (69.0%)	31 (38.8%)	< 0.001
LDH ≥ 4.22 μkat/l	22 (52.4%)	17 (21.3%)	< 0.001

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[1] Address for correspondence: Dejan Dobrijević Hajduk Veljkova 10, 21000 Novi Sad, Republic of Serbia Tel. (+381) 65 823 32 32 — Fax. (+381) 21 48 80 444 E-mail: dejan.dobrijevic@mf.uns.ac.rs