[Clinical characteristics of children with severe SARS-CoV-2 infection in Yunnan]

Zhonghua Er Ke Za Zhi. 2024 May 2;62(5):451-456. doi: 10.3760/cma.j.cn112140-20231201-00406.
[Article in Chinese]

Abstract

Objective: To investigate the clinical characteristics of 130 children with severe SARS-CoV-2 infection in Yunnan province after the relaxation of non-pharmaceutical interventions, and analyze the risk factors for mortality. Methods: This study is a retrospective case summary that analyzed the demographic data, underlying diseases, clinical diagnoses, disease outcomes, and laboratory results of 130 children with severe COVID-19 infections admitted to nine top-tier hospitals in Yunnan Province from December 2022 to March 2023. According to the prognosis, the patients were divided into survival group and death group. The clinical and laboratory data between the two groups were compared, and the risk factors of death were evaluated. The χ2 test and Mann-Whitney U test were employed to compare between groups, while Spearman correlation test and multiple Logistic regression were used to analyze the risk factors for death. The predictive value of independent risk factors was evaluated by receiver operating characteristic curve. Results: The 130 severe patients included 80 males and 50 females with an onset age of 28.0 (4.5, 79.5) months. There were 97 cases in the survival group and 33 cases in the death group with no significant differences in gender and age between the two groups (P>0.05). Twenty-five cases (19.2%) out of the 130 patients had underlying diseases, and the number with underlying diseases was significantly higher in death group than in survival group (36.4% (12/33) vs. 13.4%(13/97), χ2=8.36, P=0.004). The vaccination rate in the survival group was significantly higher than that in the death group (86.1% (31/36) vs. 7/17, χ2=9.38, P=0.002). A total of 42 cases (32.3%) of the 130 patients were detected to be infected with other pathogens, but there was no significant difference in the incidence of co-infection between the death group and the survival group (39.3%(13/33) vs. 29.9% (29/97), χ2=1.02, P>0.05). Among the 130 cases, severe respiratory cases were the most common 66 cases (50.8%), followed by neurological severe illnesses 34 cases (26.2%) and circulatory severe 13 cases (10%). Compared to the survival group, patients in the death group had a significantly higher levels of neutrophil, ferritin, procalcitonin, alanine aminotransferase, lactate dehydrogenase, creatine kinase isoenzyme, B-type natriuretic peptide, interleukin-6 and 10 (6.7 (4.0, 14.0) vs. 3.0 (1.6, 7.0)×109/L, 479 (298, 594) vs. 268 (124, 424) μg/L, 4.8 (1.7, 10.6) vs. 2.0 (1.1, 3.1) μg/L, 66 (20, 258) vs. 23 (15, 49) U/L, 464 (311, 815) vs. 304 (252, 388) g/L, 71(52, 110) vs. 24(15, 48) U/L, 484 (160, 804) vs. 154 (26, 440) ng/L, 43 (23, 102) vs. 19 (13, 27) ng/L, 216 (114, 318) vs. 86 (45, 128) ng/L, Z=-4.21, -3.67, -3.76, -3.31, -3.75, -5.74, -3.55, -4.65, -5.86, all P<0.05). The correlated indexes were performed by multivariate Logistic regression and the results showed that vaccination was a protective factor from death in severe cases (OR=0.01, 95%CI 0-0.97, P=0.049) while pediatric sequential organ failure assessment (PSOFA) (OR=3.31, 95%CI 1.47-7.47, P=0.004), neutrophil-to-lymphocyte ratio (NLR) (OR=1.56, 95%CI 1.05-2.32, P=0.029) and D dimer (OR=1.49, 95%CI 1.00-1.02, P=0.033) were independent risk factors for death (all P<0.05). The area under the curve of the three independent risk factors for predicting death were 0.86 (95%CI 0.79-0.94), 0.89 (95%CI 0.84-0.95) and 0.87 (95%CI 0.80-0.94), all P<0.001, and the cut-off values were 4.50, 3.66 and 4.69 mg/L, respectively. Conclusions: Severe SARS-CoV-2 infection can occur in children of all ages, primarily affecting the respiratory system, but can also infect the nervous system, circulatory system or other systems. Children who died had more severe inflammation, tissue damage and coagulation disorders. The elevations of PSOFA, NLR and D dimer were independent risk factors for death in severe children.

目的: 探讨云南省重症新型冠状病毒感染患儿的临床特征,并分析死亡危险因素。 方法: 回顾性病例总结,分析2022年12月至2023年3月云南省9家三甲医院收治的130例重症新型冠状病毒感染患儿的人口学资料、基础疾病、临床诊断、疾病转归及实验室结果。根据预后分为存活组和死亡组,比较两组患儿的临床及实验室资料,并分析死亡危险因素。采用χ2检验和Mann-Whitney U检验进行组间比较,采用Spearman相关性检验和多因素Logistic回归方法分析死亡危险因素,采用受试者工作特征曲线评价独立危险因素的预测价值。 结果: 130例重症患儿中男80例、女50例,起病年龄28.0(4.5,79.5)月龄。存活组97例,死亡组33例,两组患儿性别、起病年龄比较差异均无统计学意义(均P>0.05)。130例患儿中合并基础疾病25例(19.2%),死亡组合并基础病的比例高于存活组[36.4%(12/33)比13.4%(13/97),χ2=8.36,P=0.004]。存活组3岁以上患儿疫苗接种比例高于死亡组[86.1%(31/36)比7/17,χ2=9.38,P=0.002]。130例重症患儿共42例(32.3%)检出合并其他病原体感染,死亡组和存活组混合感染发生率差异无统计学意义[39.4%(13/33)比29.9%(29/97),χ2=1.02,P=0.314]。130例重症患儿中呼吸系统重症66例(50.8%),神经系统34例(26.2%)和循环系统13例(10%)。死亡组患儿中性粒细胞、铁蛋白、降钙素原、丙氨酸转氨酶、乳酸脱氢酶、肌酸激酶同工酶、B型钠尿肽、白细胞介素6和白细胞介素10水平均高于存活组[6.7(4.0,14.0)比3.0(1.6,7.0)×109/L,479(298,594)比268(124,424)μg/L,4.8(1.7,10.6)比2.0(1.1,3.1)µg/L,66(20,258)比23(15,49)U/L,464(311,815)比304(252,388)g/L,71(52,110)比24(15,48)U/L,484(160,804)比154(26,440)ng/L,43(23,102)比19(13,27)ng/L,216(114,318)比86(45,128)ng/L,Z=-4.21、-3.67、-3.76、-3.31、-3.75、-5.74、-3.55、-4.65、-5.86,均P<0.05]。将相关性指标进行多因素Logistic回归,结果显示接种疫苗是重症患儿死亡的保护因素(OR=0.01,95%CI 0~0.97,P=0.049),儿童序贯器官衰竭评估(PSOFA)(OR=3.31,95%CI 1.47~7.47,P=0.004)、中性粒细胞与淋巴细胞比值(NLR)(OR=1.56,95%CI 1.05~2.32,P=0.029)和D二聚体(OR=1.49,95%CI 1.03~2.15,P=0.033)均是死亡的独立危险因素。PSOFA、NLR和D二聚体预测死亡的曲线下面积分别为0.86(95%CI 0.79~0.94,P<0.001)、0.89(95%CI 0.84~0.95,P<0.001)和0.87(95%CI 0.80~0.94,P<0.001),截断值分别为4.50分,3.66和4.69 mg/L。 结论: 重症新型冠状病毒感染患儿可发生在各年龄段,主要累及呼吸系统,也可感染神经系统和循环系统等。死亡患儿存在更严重的炎症反应、组织损伤和凝血紊乱。PSOFA、NLR和D二聚体增高是重症患儿死亡的独立危险因素。.

Publication types

  • English Abstract

MeSH terms

  • COVID-19* / diagnosis
  • COVID-19* / epidemiology
  • COVID-19* / mortality
  • Child
  • Child, Preschool
  • China / epidemiology
  • Critical Illness
  • Female
  • Humans
  • Infant
  • Male
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2* / isolation & purification
  • Severity of Illness Index