Abstract
BackgroundEarly diagnostic indicators and the identification of possible progression to severe or critical COVID-19 in children are unknown. To investigate the immune characteristics of early SARS-CoV-2 infection in children and possible key prognostic factors for early identification of critical COVID-19, a retrospective study including 121 children with COVID-19 was conducted. Peripheral blood lymphocyte subset counts, T cell-derived cytokine concentrations, inflammatory factor concentrations, and routine blood counts were analyzed statistically at the initial presentation.ResultsThe T lymphocyte subset and natural killer cell counts decreased with increasing disease severity. Group III (critical cases) had a higher Th/Tc ratio than groups I and II (common and severe cases); group I had a higher B cell count than groups II and III. IL-6, IL-10, IFN-γ, SAA, and procalcitonin levels increased with increasing disease severity. Hemoglobin concentration, and RBC and eosinophil counts decreased with increasing disease severity. Groups II and III had significantly lower lymphocyte counts than group I. T, Th, Tc, IL-6, IL-10, RBC, and hemoglobin had relatively high contribution and area under the curve values.ConclusionsDecreased T, Th, Tc, RBC, hemoglobin and increased IL-6 and IL-10 in early SARS-CoV-2 infection in children are valuable indices for early diagnosis of severe disease. The significantly reduced Th and Tc cells and significantly increased IL-6, IL-10, ferritin, procalcitonin, and SAA at this stage in children with critical COVID-19 may be closely associated with the systemic cytokine storm caused by immune dysregulation.
Highlights
The coronavirus disease 2019 (COVID-19) outbreak in Wuhan, Hubei Province, China, in late December 2019 has been controlled by effective measures
The significantly reduced Th and Tc cells and significantly increased IL-6, IL-10, ferritin, procalcitonin, and SAA at this stage in children with critical COVID-19 may be closely associated with the systemic cytokine storm caused by immune dysregulation
Several studies have suggested that, in adults infected with SARS-CoV-2, the progression to severe cases is clearly associated with cytokine storm or cytokine storm syndrome, which is life-threatening and clinically characterized by systemic inflammation, hyperferritinemia, hemodynamic instability and multiple organ failure, and it is an important factor contributing to the lifethreatening clinical manifestations of H7N9, H5N1, and SARS [2,3,4]
Summary
The coronavirus disease 2019 (COVID-19) outbreak in Wuhan, Hubei Province, China, in late December 2019 has been controlled by effective measures. There has been no report on the indications for early diagnosis and identification of possible progression to severe or critical cases in children with SARS-CoV-2 infection. We retrospectively collected the clinical data of 121 children with confirmed and highly suspected SARSCoV-2 infection who had been admitted to Wuhan Children’s Hospital from January 25, 2020, to February 20, 2020, and analyzed the differences in the laboratory indices of peripheral blood from children with early mild and severe SARS-CoV-2 infection. To investigate the immune characteristics of early SARS-CoV-2 infection in children and possible key prognostic factors for early identification of critical COVID-19, a retrospective study including 121 children with COVID-19 was conducted. Peripheral blood lymphocyte subset counts, T cell-derived cytokine concentrations, inflammatory factor concentrations, and routine blood counts were analyzed statistically at the initial presentation
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