EVALUATION OF HEMATOLOGICAL PARAMETERS AND INFLAMMATORY MARKERS IN CHILDREN WITH COVID-19

Document Type : Original Article

Abstract

The aim of this study was to evaluate hematological parameters in children with COVID-19 and determine the effects of inflammatory biomarkers on the severity of the disease and hospitalization.
Methods: This is retrospective study on 80 COVID-19 pediatric Egyptian patients, managed in the I.C.U of the Pediatric department (Luxor Fever Hospital) during the period between May 2020 to May 2021, Egypt, the studied patients were classified into non-severe and severe/critical cases. The patient's laboratory assessment, included total leucocyte count (TLC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC), neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (d-NLR), lymphocyte to monocyte ratio (LMR), and platelets to lymphocyte ratio (PLR), as well as C reactive protein (CRP), D-dimer and serum ferritin.
Results: The severe/critical group had the highest total leucocyte count (TLC), ANC, AMC, neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (d-NLR), and platelets to lymphocyte ratio (PLR), but the lowest acute lymphocytic count (ALC) and lymphocyte to monocyte ratio (LMR) (p=0.618 and 0.001, respectively). In the severe/critical group, C - reactive protein (CRP) and d-dimer levels were found to be elevated (p0.001). In addition, the severe group had greater ferritin levels than the non-severe groups (p=0.012). We determined the appropriate cut-off values for the hematological ratios: neutrophil to lymphocyte ratio (NLR) (1.61), derived neutrophil to lymphocyte ratio (d-NLR) (1.12), platelets to lymphocyte ratio (PLR) (101) and lymphocyte to monocyte ratio (LMR) (0.61). (2.73). the specificity of derived neutrophil to lymphocyte ratio (D-NLR) was the highest (87.8%), although the sensitivity of neutrophil to lymphocyte ratio (NLR) was the highest (87.2%).
Conclusions: The predominant hematological results in our study were lymphopenia and thrombocytosis, which may be associated to the milder clinical course of COVID-19 in children. We propose that age and platelet count can be utilized as independent predictors of hospitalization in COVID-19-affected children. NLR is the main predictor of COVID-19 severity. Also neutrophil to lymphocyte ratio (d-NLR), lymphocyte to monocyte ratio (LMR), and platelets to lymphocyte ratio (PLR) were mild to moderate predictor.

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