Clinical and laboratory differences between pediatric hospitalized patients with sickle cell disease infected or not by SARS-CoV-2

Elia, Gabriella Mafra; Konstantyner, Tulio; Nais, Rafaela Pilotto; Santos, Andreia Regina Augusto dos; Angel, Andrea; Braga, Josefina Aparecida Pellegrini

doi:10.1590/1984-0462/2023/41/2021407

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Brasil

Revista Paulista de Pediatria

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Sumário

ORIGINAL ARTICLE • Rev. paul. pediatr. 41 • 2023 • https://doi.org/10.1590/1984-0462/2023/41/2021407 copy

Clinical and laboratory differences between pediatric hospitalized patients with sickle cell disease infected or not by SARS-CoV-2

Diferenças clínicas e laboratoriais entre pacientes pediátricos hospitalizados com doença falciforme infectados ou não por SARS-CoV-2

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

The aim of this study was to identify clinical and complete blood count differences between pediatric hospitalized patients with sickle cell disease infected or not by SARS-CoV-2 and compare the complete blood count of patients with sickle cell disease infected by SARS-CoV-2 before hospitalization and on admission.

Methods:

This study was a single-center prospective cohort. Data were collected from medical records of pediatric inpatients with sickle cell disease under 18 years old infected or not with SARS-CoV-2 from the first visit to the hospital until discharge and from the last medical appointment. All patients were tested for SARS-CoV-2 by the real-time reverse transcription polymerase chain reaction.

Results:

Among 57 pediatric patients with sickle cell disease hospitalized from March to November 2020 in a Brazilian academic hospital, 11 (19.3%) had a positive result for SARS-CoV-2. Patients infected by SARS-CoV-2 had a higher prevalence of comorbidities than the ones who were not infected (63.6 vs. 30.4%; p=0.046). During hospital stay, no clinical or complete blood count differences between groups were found. There was a decrease in eosinophil count on hospital admission in patients with sickle cell disease infected by SARS-CoV-2 (p=0.008).

Conclusions:

Pediatric hospitalized patients with sickle cell disease infected by SARS-CoV-2 had more comorbidities and had a decrease in eosinophil count between hospital admission and the last medical appointment.

Keywords:
Sickle cell disease; Pediatrics; SARS-CoV-2; Red blood cells; Eosinophils

Characteristics (continuous variables)	SARS-CoV-2+(n=11)		SARS-CoV-2−(n=46)		p-value*
Characteristics (continuous variables)	Median	(IQR)	Median	(IQR)	p-value*
Age (years)	10.5	(6.6–16.2)	11.0	(8.0–14.6)	0.777
Hospitalization days	6.0	(3.0–10.0)	7.0	(4.0–9.0)	0.738
BAZ	0.3	(-1.59–1.35)	-0.43	(-1.07–0.35)	0.375
HAZ	-1.03	(-2.50–-0.55)	-0.93	(-1.57–-0.39)	0.470
Characteristics (categorical variables)	SARS-CoV-2 + (n=11)		SARS-CoV-2 − (n=46)		p-value^†
Characteristics (categorical variables)	P (%)	(95%CI)	P (%)	(95%CI)	p-value^†
Non-white ethnicity	81.8	(42.0–96.5)	82.6	(68.3–91.3)	0.625
Male gender	36.4	(11.7–71.2)	41.3	(27.7–54.4)	0.522
Severe genotype	81.8	(42.0–96.5)	84.8	(70.7–92.8)	0.558
Presence of any comorbidity	63.6	(28.8–88.3)	30.4	(18.5–45.7)	0.046
Hydroxyurea or chronic transfusion	81.8	(42.0–96.5)	63.0	(47.8–76.1)	0.206
Macrolides	54.5	(22.6–83.2)	52.2	(37.4–66.6)	0.578
Other antibiotics	100	–	89.1	(75.8–95.6)	0.327
Oseltamivir	27.3	(7.2–64.6)	19.6	(10.2–34.1)	0.421

Clinical manifestations and diagnoses	SARS-CoV-2+(n=11)		SARS-CoV-2−(n=46)		p-value*
Clinical manifestations and diagnoses	P (%)	(95%CI)	P (%)	(95%CI)	p-value*
On admission
Fever	45.5	(16.8–77.4)	28.3	(16.8–43.4)	0.226
Cough, rhinorrhea, or sneezing	18.2	(3.5–58.0)	17.4	(8.7–31.7)	0.625
Chest pain	27.3	(7.2–64.6)	19.6	(10.2–34.1)	0.421
Diarrhea, nausea, or vomiting	18.2	(3.5–58.0)	10.9	(4.4–24.2)	0.408
Vaso-occlusive crisis	63.6	(28.8–88.3)	87.0	(73.2–94.2)	0.088
During hospitalization (maintenance or recurrence)
Fever	90.9	(46.3–99.1)	60.9	(45.7–74.2)	0.055
Cough, rhinorrhea, or sneezing	27.3	(7.2–64.6)	30.4	(18.6–45.7)	0.576
O₂ saturation <93%	72.7	(35.4–92.8)	56.5	(41.5–70.4)	0.264
Diarrhea, nausea, or vomiting	9.1	(0.9–53.7)	6.5	(2.0–19.1)	0.587
Vaso-occlusive crisis	63.6	(28.8–88.3)	82.6	(68.3–91.3)	0.164
Acute chest syndrome	45.5	(16.8–77.4)	52.2	(37.4–66.6)	0.474

Laboratory tests	SARS-CoV-2+(n=11)		SARS-CoV-2−(n=46)		p-value*
Laboratory tests	Median	(IQR)	Median	(IQR)	p-value*
Hemoglobin (g/dL)	8.8	(8.0–9.8)	8.8	(7.5–9.8)	0.686
Leukocytes (/μL)	13,518	(11,412–23,600)	16,250	(11,960–21,710)	0.628
Neutrophils (/μL)	8,787	(5,277–14,465)	9,535	(7,220–13,990)	0.856
Eosinophils (/μL)	99	(0–217)	158	(0–328)	0.330
Lymphocytes (/μL)	3,369	(1,942–5,137)	3,384	(2,613–6,320)	0.332
Monocytes (/μL)	1,745	(656–2494)	1,206	(873–1,887)	0.777
Platelets (/μL)	411,000	(230,000–449,000)	356,500	(264,000–483,000)	0.911

Laboratory tests	Before hospitalization (n=11)		On admission (n=11)		p-value*
Laboratory tests	Median	(IQR)	Median	(IQR)	p-value*
Hemoglobin (g/dL)	9.0	(7.8–9.9)	8.8	(8.0–9.8)	0.350
Leukocytes (/μL)	11,820	(9,970–13,049)	13,518	(11,412–23,600)	0.131
Neutrophils (/μL)	6,003	(4,208–6,619)	8,787	(5,277–14,465)	0.091
Eosinophils (/μL)	366	(266–789)	99	(0–217)	0.008
Lymphocytes (/μL)	3,538	(2,661–4,925)	3,369	(1,942–5,137)	0.929
Monocytes (/μL)	1,200	(990–1,460)	1,745	(656–2494)	0.248
Platelets (/μL)	414,000	(262,000–561,000)	411,000	(230,000–449,000)	0.286
Reticulocytes (%)	8.85	(6.90–13,07)	10.72	(6.80–14.60)	0.441

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[1] *Corresponding author: E-mail: tkmed@uol.com.br (T. Konstantyner).