Cardiac Affection in COVID-19 Pediatrics and its Correlation with Inflammatory Markers

Abstract

Abstract Background Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused a pandemic of respiratory and cardiovascular diseases, known as coronavirus disease 2019 (COVID-19). However, the respiratory system is the primary target of SARS-CoV-2, it also causes a systemic illness with widespread inflammation and cytokine flood, resulting in acute respiratory distress syndrome (ARDS), severe cardiovascular injury, multiorgan failure (MOF), and death in its most severe form. COVID-19 progression severity can be detected by cardiac signs. Detection of subtle cardiac damage early allows for providing efficient treatment. Objective The current study aimed to detect cardiac involvement in COVID-19 and its correlation with other inflammatory markers elevated in COVID-19 patients. Methods This retrospective analytical observational study included a total of 72 patients diagnosed as positive for COVID-19, depending on PCR of nasopharyngeal swabs, at Children’s Hospital, Ain Shams University in the period between December 2021 to March 2022. Patients included were within the pediatrics age group, from 4 months to 16 years old. They underwent full clinical examination, laboratory investigations, chest radiological studies, and echocardiographic assessment after 48 hours of admission. These patients were admitted in the isolation unit and later 30 (41.6%) patients were admitted in PICU. Patients were further grouped into 2 groups: Group I without cardiac affection, and Group II with cardiac affection. Results Patients with cardiac affection (group II) had more thrombocytopenia (61.5%) (P-value = 0.037), higher ESR (Median (IQR) = 62.5 (33 – 90))(P-value = 0.000), higher D- dimer (Median (IQR) = 4.25 (2.33–7.37))(P-value = 0.001), higher serum ferritin (Median (IQR) = 1200 (1022–3421))(P-value = 0.281), higher CK-MB (Median (IQR) = 33.5 (28–46)) (P-value = 0.000) and as a consequence, higher troponin I (Median (IQR) = 0.24 (0.1–0.46))(P-value = 0.000). Regarding Echo findings, cardiac affection showed a lower ejection fraction in (88.5%) of group II patients with Mean±SD (50.23 ± 6.69) (P-value = 0.000). The most frequent Echo finding was carditis (46.2%), followed by valvular lesions (42.3%), especially Tricuspid regurge. All the non-survivor (dead) cases (only 8 patients) were with cardiac affection. Conclusions COVID-19 can cause cardiovascular complications in pediatrics and correlate with inflammatory markers of COVID-19, which also can predict severe prognosis.