27 - Interaction Between Laboratory Tests and SARS-CoV-2 Test Status on Severe Outcome Among Hospitalized Children

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 27
Publication Number: 27.11

Jianling Xie, University of Calgary, Calgary, AB, Canada; Nathan Kuppermann, UC Davis School of Medicine, Sacrametno, CA, United States; Todd A. Florin, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Daniel J. Tancredi, University of California, Davis, School of Medicine, Sacramento, CA, United States; Anna Funk, University of Calgary, Calgary, AB, Canada; Kelly Kim, The University of Calgary, Calgary, AB, Canada; Stephen Freedman, University of Calgary, Calgary, AB, Canada

Presenting Author(s)

Stephen Freedman, MDCM, MSc (he/him/his)

Professor of Pediatrics and Emergency Medicine
University of Calgary
Calgary, Alberta, Canada

Background:

Although laboratory abnormalities associated with severe outcomes of COVID-19 in children could inform clinical decision-making, few studies have explored such associations.

Objective:

1) To assess the association between laboratory findings and severe outcomes among children hospitalized with SARS-CoV-2 infections, and
2) To determine if SARS-CoV-2 test result status (positive vs. negative) modifies these associations.

Design/Methods:

We analyzed cross-sectional data from participants recruited in 41 pediatric emergency departments in 10 countries between March 18, 2020 and June 15, 2021. Eligible participants were tested for SARS-CoV-2 infection, had symptoms potentially attributable to infection, were hospitalized and completed 14-day follow-up. Our composite outcome of severe disease was defined by the performance of intensive interventions, development of severe organ impairment, or death. We used multivariable models to assess the associations between laboratory parameters and severity and assessed whether SARS-CoV-2 infection modified these associations.

Results:

We included 1817 participants including 522 (28.7%) who were SARS-CoV-2 test-positive and 1295 (71.3%) who were test-negative. Seventy-five (14.4%) test-positive and 174 (13.4%) test-negative children experienced severe outcomes. Among SARS-CoV-2 positive children, serum ferritin >500 ng/mL [aOR (95%CI): 7.95 (1.89, 33.44)], serum procalcitonin >0.35 ng/mL [6.18 (1.98, 19.31)], D-dimer ≥1500 ng/mL [4.57 (1.12, 18.68)], absolute lymphocyte count < 1.0×10⁹/L [3.21 (1.34, 7.69)], platelet count < 150×10⁹/L [2.82 (1.31, 6.07)], and serum glucose ≥120 mg/dL [2.01 (1.06, 3.81)] were associated with severe outcome. A positive SARS-CoV-2 result increased the associations with severe outcome for elevated serum procalcitonin, CRP, D-dimer, and reduced absolute lymphocyte and platelet counts.

Conclusion(s):

We identified laboratory parameters that are associated with severe outcomes in SARS-CoV-2-infected children. As laboratory testing interacted with SARS-CoV-2 status, elevated serum procalcitonin, CRP, and D-dimer, and low absolute lymphocyte and platelet counts were more strongly associated with severe outcomes in children testing positive for SARS-CoV-2 vs negative.