Overall, 187 pediatric patients including 120 (64.2%) male and 67 (35.8%) female with COVID-19 infection were enrolled in this study. The median (Interquartile range: IQR) age of the study population was 60 (24-114) months and the median (IQR) hospital admission duration was 5 (3-8.25) days.
The median (IQR) body mass index (BMI) was 16.0 (13.0-18.6). Based on the BMI, patients were categorized as underweight (n=127, 68.3%), normal (n=42, 22.6%), overweight (n=13, 7%), and obese (n=4, 2.2%).
The COVID-19 evidence was observed in CXR of 73.8% (79 of 107) and chest CT scan of 74.6% (85 of 114) of patients. The COVID-19 RT-PCR was evaluated in 84 patients with positive result in 30 (35.7%) and negative result in 54 (64.3%) patients.
The blood pressure at the presentation was evaluated in 148 patients, who were normal in 126 (85.1%), low in 12 (8.1%) and high in 10 (6.8%) patients. At discharge, the blood pressure was in the normal range for 111 out of 116 (95.7%) patients and high in 5 (4.3%) patients.
Underlying comorbidities consisted of malnutrition (n=144, 77.4%), neurologic/learning disorders (n=40, 21.4%), malignancy (n=19, 10.2%), inborn errors of metabolic (n=14, 7.5%), cardiovascular disorder (n=13, 7%), gastrointestinal/hepatic disorders (n=10, 5.3%), chronic pulmonary disorders (n=9, 4.8%), inborn errors of immunity (n=9, 4.8%), and hematologic disorder (n=8, 4.3%).
Positive nephrotoxic drug history was reported in 20 cases (10.7%); angiotensin-converting enzyme inhibitor (n=10, 5.3%), nonsteroidal anti-inflammatory drugs (n=5, 2.7%), trimethoprim/sulfamethoxazole (n=5, 2.7%), calcineurin inhibitors (n=2, 1.1%) and vancomycin (n=1, 0.5%).
Reduced urine volume before admission was detected in 26 (14.3%) patients, edema in 13 (7.1%), urine discoloration in 3 (1.6%), and dysuria in 2 (1.1%) patients.
During hospital admission, organ involvements were as follows: lung (n=100, 53.5%), gastrointestinal tract (n=73, 39%), kidney (n=30, 16%), skin (n=7, 3.7%), heart (n=5, 2.7%), and central nervous system (n=4, 2.1%). In addition, 20 (10.7%) patients developed multisystem inflammatory syndrome (MIS-C).
According to the normal range for age, the serum creatinine level at the presentation was in the AKI range in 72 (38.5%) of 187 evaluated patients. Based on the KDIGO classification, patients with AKI were categorized as stage 1 (n=40, 55.6%), stage 2 (n=26, 36.1%), and stage 3 (n=6, 8.3%). The comparison of the demographic data, clinical and laboratory findings of patients in AKI or non-AKI groups is presented in Table 1.
Most of the patients (n=115, 65.7%) had normal level of leukocytes. Leukocytosis and leukopenia were reported in 32 (18.3%) and 28 (16%) patients, respectively. Majority of patients had normal neutrophil (n=100, 68.5%), lymphocytes (91, 70%), and platelets (73, 51%). While, lymphopenia (n=19, 14.6%), neutropenia (n=12, 8.2%), and thrombocytopenia (n=33, 23.1%) were found in minor groups. Inflammatory markers including ESR (35 of 53, 66%) and lactate dehydrogenase (LDH) (56 of 59, 94.9%), were elevated in most of the evaluated patients.
There was no significant correlation between AKI staging and white blood cell (WBC) (p=0.888), neutrophil (p=0. 228), lymphocyte (p=0.420), or LDH (p=0.218) count at presentation.
Severe COVID19 disorder was detected in 66 (35.3%) patients. Electrolyte abnormalities was reported in 95 (72.5%) patients. The most frequent electrolyte abnormalities included hyponatremia (46, 35.4%), hypernatremia (4, 3.1%), hypokalemia (11, 8.5%), hyperkalemia (22, 16.9%), hypocalcemia (40, 52.6%), hypophosphatemia (38, 59.4%), and hypermagnesemia (38, 62.3%).
44 patients (23.5%) were admitted in the pediatric intensive care unit (PICU) setting and 27 (14.4%) patients required intubation. There was no significant association between AKI and PICU admission (p=0.079), MIS-C (p=0.051), and comorbidities (p=0.067). Nine patients (4.8%) required hemodialysis. 16 (8.6%) patients were eventually died. The mortality rate was approximately equal in patients with AKI and without AKI (9.7% vs. 7.8%, p=0.789). (Table 2)