Thrombosis and hemorrhage experienced by hospitalized children with SARS-CoV-2 infection or MIS-C: Results of the PICNIC registry.

Abstract

IntroductionCoagulopathy and thrombosis associated with SARS‐CoV‐2 infection are well defined in hospitalized adults and leads to adverse outcomes. Pediatric studies are limited.MethodsAn international multicentered (n = 15) retrospective registry collected information on the clinical manifestations of SARS‐CoV‐2 and multisystem inflammatory syndrome (MIS‐C) in hospitalized children from February 1, 2020 through May 31, 2021. This sub‐study focused on coagulopathy. Study variables included patient demographics, comorbidities, clinical presentation, hospital course, laboratory parameters, management, and outcomes.ResultsNine hundred eighty‐five children were enrolled, of which 915 (93%) had clinical information available; 385 (42%) had symptomatic SARS‐CoV‐2 infection, 288 had MIS‐C (31.4%), and 242 (26.4%) had SARS‐CoV‐2 identified incidentally. Ten children (1%) experienced thrombosis, 16 (1.7%) experienced hemorrhage, and two (0.2%) experienced both thrombosis and hemorrhage. Significantly prevalent prothrombotic comorbidities included congenital heart disease (p‐value .007), respiratory support (p‐value .006), central venous catheter (CVC) (p = .04) in children with primary SARS‐CoV‐2 and in those with MIS‐C included respiratory support (p‐value .03), obesity (p‐value .002), and cytokine storm (p = .012). Comorbidities prevalent in children with hemorrhage included age >10 years (p = .04), CVC (p = .03) in children with primary SARS‐CoV‐2 infection and in those with MIS‐C encompassed thrombocytopenia (p = .001) and cytokine storm (p = .02). Eleven patients died (1.2%), with no deaths attributed to thrombosis or hemorrhage.ConclusionThrombosis and hemorrhage are uncommon events in children with SARS‐CoV‐2; largely experienced by those with pre‐existing comorbidities. Understanding the complete spectrum of coagulopathy in children with SARS‐CoV‐2 infection requires ongoing research.