Abstract
Background We aimed to identify clinical features of coronavirus disease 2019 (COVID-19) in children and evaluate the role of procalcitonin in early differential diagnosis.
Methods A retrospective analysis was performed on all suspected pediatric cases.
Results 39 (50.6%) of 77 suspected cases were comfirmed, 4 (5.2%) of them had viral coinfection. Compared with non-COVID-19 group (n=33), COVID-19 confirmed group (n=39) had fewer fever(OR[95% CI]0.467[0.314-0.694]; P=.000) and symptoms of acute respiratory infection (0.533[0.36–0.788]; P=.001), more asymptomatic (13.568[1.895-96.729]; P=.000), and more family cluster infections (5.077[2.224-11.591]; P=.000), while computed tomography had more positive findings of viral pneumonia (1.822[1.143-2.906]; P=.008). Age (6.9[3.6-10.5] vs 5[2.1-7.6]; P=. 088) and gender were statistically insignificant. Procalcitonin (0.05[0.029-0.076] vs 0.103[0.053-0.21]; P= 000) of COVID-19 alone group (n=35) was significantly reduced. While compared with coinfection group (n=4), procalcitonin (0.05[0.029-0.076] vs 0.144[0.109-2.26]; P=.010) was also reduced. The area under curve of model is 0.834 ([95% CI][0.741-0.926]; P=.000). Procalcitonin as a differential indicator of COVID-19 alone, its area under curve is 0.809 ([0.710-0.909]; P=.000). The optimal cut-off value is 0.1 ng/mL, the sensitivity, specificity, positive and negative predictive value of differentiating are 65.9%, 78.6%, 82.9%, and 59.2%, respectively.
Conclusions Asymptoms or mild symptoms, positive computed tomography findings and family cluster infection are the main clinical features of COVID-19 in children. With good performance, procalcitonin can provide an important basis for differentiating COVID-19 alone and other viral infection or viral coinfection.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
Did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author Declarations
All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.
Yes
All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.
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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
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I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.
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Data Availability
All data in this paper is true, reliable and available.
Abbreviations
- ARI
- acute respiratory infection
- AUC
- area under curve
- CAP
- community acquired pneumonia
- CI
- confidence interval
- COVID-19
- 2019 novel coronavirus disease
- CT
- computed tomography
- hs-CRP
- high sensitivity C-reactive protein
- Hb
- Hemoglobin
- INFA,B
- influenza A,B
- IQR
- interquartile range
- LC
- lymphocyte count
- L%
- percentage of lymphocyte
- MP
- mycoplasma pneumoniae
- NPV
- negative predictive value
- N%
- percentage of neutrophil
- NC
- neutrophil count
- OR
- odds ratio
- PCT
- procalcitonin
- PPV
- positive predictive value
- PLT
- platelet
- ROC
- receiver operating characteristic curve
- RSV
- respiratory syncytial virus
- RT-PCR
- real-time reverse transcriptase polymerase chain reaction
- SD
- standard deviation
- SE
- standard error
- WBC
- white blood cell.