Comparison of coagulopathy values in children with covid-19 and other viral infections

Background: The SARS-CoV-2 infection epidemic is a multi-systemic disease that primarily involves the respiratory tract, caused by a novel coronavirus and was first detected in Wuhan, China in December 2019. Called coronavirus Disease 2019 (COVID-19) by the World Health Organization (WHO), the main clinical symptoms of the highly contagious disease are fever, dry cough, fatigue, muscle pain, and shortness of breath. It was officially declared as a pandemic by the World Health Organization, with the death of more than 4000 people on March 11, 2020. Although more than 35 million definite cases of COVID-19 and over 1 million deaths have been reported worldwide so far, the numbers continue to increase. Children with COVID-19 usually have mild signs of respiratory infections. Although the virus shows mild to moderate symptoms in most patients, in 15% of the cases, can progress to the severe conditions such as systemic inflammatory response syndrome (SIRS), acute respiratory distress syndrome (ARDS), multi-organ involvement, diffuse intravascular coagulation (DIC) and shock. The development of coagulopathy is one of the most important poor prognosis indicators in these patients. The data obtained show that coagulopathy has an important place in the pathogenesis of COVID-19 infection. In our study, we investigated the significant changes in coagulopathy and D-Dimer parameters in the pediatric age group as in adults in SARS-CoV-2 infection, and also about the coagulation cascade triggered by the inflammatory process in other viral infections other than COVID-19 and its relationship with the severity and course of the infection. It was aimed to examine and compare the data of these two groups in terms of differences. Material and methods: Patients who were admitted to Bezmialem Vakıf University Hospital Pediatric Clinic between March 2020 and September 2020 and whose age range was between 1 month and 18 years, with COVID-19 infection and those with other viral infections other than COVID-19 were included in the study. Coagulopathy values (PT, INR, APTT, Fibrinogen, D-Dimer), complete blood count, biochemical values (CRP, ALT, AST, LDH), history / physical examination findings and chest radiographs were evaluated and compared. Results: In our study, the age of COVID-19 patients was found to be significantly higher than the group with other viral infections. It was shown that COVID-19 (+) patients had a significantly higher D-Dimer value compared to the group with COVID-19 (-). In addition, these values were found to be higher in COVID-19 (+) patients with moderate clinical stage than those with mild or asymptomatic patients. No significant difference was found between the fibrinogen of COVID-19 (+) and the other group with non-COVID-19 viral infection. In our study, it was determined that D-Dimer has no prognostic value as a screening test in non-COVID-19 (-) viral infections, and routine monitoring would not make a significant difference. PT, INR, APTT values were shown to be significantly higher in COVID-19 (-) patients compared to COVID-19 (+) patients. No significant difference was found in hemogram results of children with COVID-19 (+) and with mild to moderate symptoms, in terms of leukopenia, neutropenia, lymphopenia, lymphocytosis, monocytosis, increased neutrophil / lymphocyte ratio (NLR), thrombocytopenia and thrombocytosis compared to other viral infections. In our study, it was found that COVID-19 (+) patients had a significantly higher headache complaint than the group with COVID-19 (-). HGB, MCV and HCT values were found to be significantly higher in patients with COVID-19 (+) compared to the group with other viral infections. Keywords: COVID-19, pediatric, coagulopathy, D-Dimer, ACE-2, child, non-COVID-19 viral infections