Lab Value Predictive of COVID-19 Disease Severity in Children

A study has found measurements of C-reactive protein (CRP), lactate dehydrogenase (LDH) and albumin are potentially predictive markers for disease severity in children hospitalized with COVID-19. 

The multicenter retrospective cohort study at four pediatric referral hospitals in Iran between April 2020 and March 2021 assessed the discriminative ability of laboratory and clinical parameters to pinpoint predictors of disease severity and mortality among children hospitalized with COVID-19. Patients aged 18 and younger who were admitted to the hospital and tested positive for SARS-CoV-2 via reverse transcriptase-polymerase chain reaction (RT-PCR) were eligible for inclusion. COVID-19 severity was classified as either severe/critical or mild/moderate, depending on respiratory failure, shock, organ failure, severe pneumonia, hypoxia, elevated respiratory rate, and abnormal blood gas analysis results. Using demographic, clinical and laboratory data, a predictive model was developed, the performance of which was evaluated using metrics such as sensitivity, specificity, positive predictive value rates and receiver operating characteristics. Logistic regression models were used in statistical analyses.

A total of 468 patients (median age, 4.2; boys, 52.9 percent; median duration of hospital stay, six days) were included in the study, 67 (14.3 percent) of whom had severe/critical disease and 401 (85.7 percent) of whom had mild/moderate disease. The median hospitalization stay was 12 days and 15 days among those in the severe/critical and deceased groups, respectively. Of the 23 (4.9 percent) patients who died, 19 (86.2 percent) had underlying conditions. Fever (64.5 percent) and cough (41.5 percent) were the two most frequently reported symptoms among all patients.

Overall, 36.5 percent of patients had underlying conditions. Underlying conditions were more prevalent among patients with severe/critical disease versus those with mild/moderate disease (80 percent versus 36.5 percent). The prevalence of abnormal chest computed tomography (CT) findings was not significantly different between the 2 groups.

Although median white blood cell count (WBC) and polymorphonuclear leukocyte count did not differ between the two groups, several other laboratory markers did differ. Patients with severe/critical versus mild/moderate disease had significantly higher neutrophil-to-lymphocyte ratios and LDH levels. In contrast, patients with mild/moderate versus severe/critical disease had higher median lymphocyte count and serum albumin levels. Significant differences in the presence of underlying conditions, WBC count, albumin levels, LDH levels and CRP levels were also found between patients who died vs those who recovered.

Respiratory distress, tachypnea, hypotension, acute kidney damage, intubation requirement and oxygen requirement were significantly more prevalent in the severe/critical versus mild/moderate disease group and were associated with higher mortality rate. Edema of the hands and feet was also significantly associated with mortality and disease severity.

The area under the curve (AUC) for disease severity and death was 0.818 and 0.873, respectively. Specifically, a strong predictive ability was demonstrated by albumin, CRP, and LDH.

“By understanding factors that influence disease progres­sion and severity in pediatric cases, healthcare providers can better tailor treatment strategies, allocate resources effectively, and improve outcomes for children affected by the virus,” the researchers concluded.