Hematological Parameters and Inflammatory Markers in Children with Multisystem Inflammatory Syndrome

Year 2022, Volume: 32 Issue: 4, 415 - 424, 31.08.2022

Gülsüm Alkan , Ahmet Sert , Şadiye Kübra Tüter Öz , Melike Emiroğlu

https://doi.org/10.54005/geneltip.1104257

Cited By: 2

Abstract

Abstract
Objective:
Multisystem inflammatory syndrome in children (MIS-C), is a newly recognised life-threatening complication of coronavirus disease 2019 (COVID-19). Early determination of clinical severity of the disease is important for early decision of treatment regimens. The aim of this study is to investigate the severity classification value of a number of hematological parameters, inflammatory markers and biochemical tests in patients with MIS-C during the acute stage and after anti-inflammatory treatment.
Material and Methods:
In this retrospective case-controlled study, 64 children with MIS-C and 95 healthy age and gender matched children were included. Patients were divided into three clinical severity groups; mild, moderate, and severe.
Results:
Mean platelet volume (MPV), MPV to lymphocyte ratio (MPVLR), D-dimer, ferritin, interleukin 6 (IL-6) levels were significantly higher, while albumin levels were lower in the severe MIS-C group compared to all the other groups on admission. Neutrophil-to-lymphocyte ratio (NLR) and derived (d) NLR (d-NLR) levels were significantly higher in the moderate group compared to the mild group. In the pre-treatment period of MIS-C patients had higher MPV, platelet distribution width (PDW) values while they had lower white blood cell, lymphocyte, monocyte, haemoglobin, mean corpuscular volume (MCV), red cell distribution width (RDW), plateletcrit and platelet values compared to the post-treatment group.
Lymphocyte, platelets, and haemoglobin levels were significantly higher in the control group compared to the pre-treatment group. Acute phase reactants, NLR, NMR, PLR, d-NLR, MPVLR and systemic inflammatory index were significantly higher in all MIS-C patients on admission compared to the control group.
Conclusion: Specific routine laboratory test results may be useful in determining disease severity of MIS-C, possibly predict the prognosis and allow early initiation of the appropriate treatment.

Keywords

disease severity, ; haematological parameters;, inflammatory markers;, Multisystem inflammatory syndrome in children

Hematological Parameters and Inflammatory Markers in Children with Multisystem Inflammatory Syndrome

Abstract

Abstract
Objective:
Multisystem inflammatory syndrome in children (MIS-C), is a newly recognised life-threatening complication of coronavirus disease 2019 (COVID-19). Early determination of clinical severity of the disease is important for early decision of treatment regimens. The aim of this study is to investigate the severity classification value of a number of hematological parameters, inflammatory markers and biochemical tests in patients with MIS-C during the acute stage and after anti-inflammatory treatment.
Material and Methods:
In this retrospective case-controlled study, 64 children with MIS-C and 95 healthy age and gender matched children were included. Patients were divided into three clinical severity groups; mild, moderate, and severe.
Results:
Mean platelet volume (MPV), MPV to lymphocyte ratio (MPVLR), D-dimer, ferritin, interleukin 6 (IL-6) levels were significantly higher, while albumin levels were lower in the severe MIS-C group compared to all the other groups on admission. Neutrophil-to-lymphocyte ratio (NLR) and derived (d) NLR (d-NLR) levels were significantly higher in the moderate group compared to the mild group. In the pre-treatment period of MIS-C patients had higher MPV, platelet distribution width (PDW) values while they had lower white blood cell, lymphocyte, monocyte, haemoglobin, mean corpuscular volume (MCV), red cell distribution width (RDW), plateletcrit and platelet values compared to the post-treatment group.
Lymphocyte, platelets, and haemoglobin levels were significantly higher in the control group compared to the pre-treatment group. Acute phase reactants, NLR, NMR, PLR, d-NLR, MPVLR and systemic inflammatory index were significantly higher in all MIS-C patients on admission compared to the control group.
Conclusion: Specific routine laboratory test results may be useful in determining disease severity of MIS-C, possibly predict the prognosis and allow early initiation of the appropriate treatment.
Keywords: disease severity; haematological parameters; inflammatory markers; Multisystem inflammatory syndrome in children

ÖZ
Amaç: Çocuklarda multisistem inflamatuar sendrom (MIS-C), coronavirus disease 2019 (COVID-19)’un yeni tanımlanan yaşamı tehdit eden bir komplikasyonudur. Hastalığın klinik şiddetinin erken tespiti, tedavi rejimlerine erken karar verilmesinde önemlidir. Bu çalışmanın amacı, MIS-C'li hastalarda hematolojik parametrelerin, inflamatuar belirteçlerin ve biyokimyasal testlerin hastalığın cidiyetine göre, akut dönemde ve antiinflamatuar tedavi sonrasındaki değerlerini araştırmaktır.
Gereç ve Yöntem: Retrospektif vaka kontrollü çalışmaya MIS-C tanısı alan 64 çocuk ve yaş ve cinsiyet uyumlu 95 sağlıklı çocuk dahil edildi. Hastalar klinik bulgulara göre; hafif, orta ve şiddetli olarak üç gruba ayrıldı.
Bulgular: Ciddi MIS-C kliniğinde olan hastalarda hastaneye başvuruda ortalama trombosit hacmi (MPV), MPV/lenfosit oranı (MPVLR), D-dimer, ferritin, interlökin 6 (IL-6) seviyeleri anlamlı olarak daha yüksekken, albumin düzeyleri daha düşüktü. Klinik şiddeti orta olan hastalarda hafif olan hastalara göre; Nötrofil-lenfosit oranı (NLR) ve derived NLR (d-NLR) seviyeleri anlamlı olarak daha yüksek saptandı. MIS-C hastalarında tedavi öncesinde tedavi sonrasına göre MPV, trombosit dağılım genişliği (PDW) değerleri daha yüksekken; beyaz küre sayısı, lenfosit, monosit, hemoglobin, ortalama korpüsküler hacim (MCV), kırmızı hücre dağılım genişliği (RDW), plateletcrit ve trombosit değerleri daha düşüktü. Kontrol grubunda, tedavi öncesi gruba göre lenfosit, trombosit ve hemoglobin düzeyleri anlamlı derecede yüksekti.Akut faz reaktanları, NLR, nötrofil monosit oranı, plateler lenfosit oranı, d-NLR, MPVLR ve sistemik inflamatuar indeks, kontrol grubuna kıyasla tüm MIS-C hastalarında başvuru sırasında anlamlı derecede yüksekti.
Sonuç: Spesifik rutin laboratuvar test sonuçları, MIS-C'nin hastalık şiddetini belirlemede, prognozu öngörmede, ve uygun tedavinin erken başlatılmasında yararlı olabilir.
Anahtar kelimeler: hastalık şiddeti; hematolojik parametreler; inflamatuar belirteçler; çocuklarda multisistem inflamatuar sendrom

Keywords

disease severity, haematological parameters;, inflammatory markers;, Multisystem inflammatory syndrome in children

References

• References Referans 1. Borrelli M, Corcione A, Castellano F, et al. Coronavirus Disease 2019 in Children. Front Pediatr 2021; 9:668484. Referans 2. Kabeerdoss J, Pilania RK, Karkhele R, et al (2021) Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management. Rheumatol Int 2021; 41:19–32.
• Referans 3. Sancho-Shimizu V, Brodin P, Cobat A, et al. SARS-CoV-2-related MIS-C: A key to the viral and genetic causes of Kawasaki disease? J Exp Med 2021;218(6): e20210446.
• Referans 4. Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-System inflammatory syndrome in children (MIS-C) following SARS-CoV-2 Infection: Review of clinical presentation, hypothetical pathogenesis, and proposed management. Children (Basel). 2020;7(7):69.
• Referans 5. Simon Junior H, Sakano TMS, Rodrigues RM, et al. Multisystem inflammatory syndrome associated with COVID-19 from the pediatric emergency physician’s point of view. J Pediatr (Rio J) 2021; 97:140–159.
• Referans 6. Bartsch YC, Wang C, Zohar T, et al. Humoral signatures of protective and pathological SARS-CoV-2 infection in children. Nat Med 2021; 27:454–62.
• Referans 7. Vella LA, Giles JR, Baxter AE, et al. Deep immune profiling of MIS-C demonstrates marked but transient immune activation compared to adult and pediatric COVID-19. Sci Immunol. 2021;6(57): eabf7570.
• Referans 8. Schvartz A, Belot A, Kone-Paut I. Pediatric inflammatory multisystem syndrome and rheumatic diseases during SARS-CoV-2 pandemic. Front Pediatr 2020; 8:605807.
• Referans 9. Ying H-Q, Deng Q-W, He B-S, et al. The prognostic value of preoperative NLR, d-NLR, PLR and LMR for predicting clinical outcome in surgical colorectal cancer patients. Med Oncol 2014;31(12):305.
• Referans 10. Henderson LA, Canna SW, Friedman KG, et al. American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 2. Arthritis Rheumatol 2021;73: e13–e29.
• Referans 11. Jonat B, Gorelik M, Boneparth A, et al. Multisystem inflammatory syndrome in children associated with Coronavirus Disease 2019 in a children’s hospital in New York City: Patient characteristics and an institutional protocol for evaluation, management, and follow-up. Pediatr Crit Care Med 2021;22: e178–91.
• Referans 12. World Health Organization. Coronavirus Disease (COVID-19) Dashboard. Geneva, Switzerland: World Health Organization. 2020. https://covid19.who.int
• Referans 13. Valverde I, Singh Y, Sanchez-de-Toledo J, et al. Acute Cardiovascular manifestations in 286 children with multisystem inflammatory syndrome associated with COVID-19 infection in Europe. Circulation 2021: 143:21–32.
• Referans 14. Henderson LA, Yeung RSM.MIS-C: early lessons from immune profiling. Nat Rev Rheumatol 2021; 17:75–6.
• Referans 15. Zhao Y, Yin L, Patel J, et al. The inflammatory markers of multisystem inflammatory syndrome in children (MIS-C) and adolescents associated with COVID-19: A meta-analysis. J Med Virol 2021; 93:4358–69.
• Referans 16. Kaufmann CC, Ahmed A, Brunner U, et al. Red cell distribution width upon hospital admission predicts short-term mortality in hospitalized patients with COVID-19: A Single-center experience. Front Med 2021; 8:652707.
• Referans 17. Yoon HE, Kim SJ, Hwang HS, et al. Progressive rise in red blood cell distribution width predicts mortality and cardiovascular events in end-stage renal disease patients. PLoS One 2015;10(5): e0126272.
• Referans 18. Tekin YK, Tekin G. Mean Platelet Volume-to-Platelet Count Ratio, Mean Platelet Volume-to-Lymphocyte Ratio, and Red Blood Cell Distribution Width-Platelet Count Ratio as markers of inflammation in patients with ascending thoracic aortic aneurysm. Brazilian J Cardiovasc Surg 2020; 35:175–180.
• Referans 19. Korniluk A, Koper-Lenkiewicz OM, Kamińska J, et al Mean Platelet Volume (MPV): New perspectives for an old marker in the course and prognosis of inflammatory conditions. Mediators Inflamm 2019; 2019:9213074.
• Referans 20. Zhang S, Liu Y, Wang X, et al. SARS-CoV-2 binds platelet ACE2 to enhance thrombosis in COVID-19. J Hematol Oncol 2020; 13:120.
• Referans 21. Han H, Ma Q, Li C, et al. Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors. Emerg Microbes Infect 2020; 9:1123–1130.
• Referans 22. Rowaiye AB, Okpalefe OA, Onuh Adejoke O, et al. Attenuating the effects of novel COVID-19 (SARS-CoV-2) Infection-induced cytokine storm and the implications. J Inflamm Res.2021; 14:1487–1510.
• Referans 23. Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. Clin Chim Acta 2020; 505:190–1.
• Referans 24. Magro G. Cytokine Storm: Is it the only major death factor in COVID-19 patients? Coagulation role. Med Hypotheses 2020; 142:109829.
• Referans 25. Vargas-Vargas M, Cortés-Rojo C. Ferritin levels and COVID-19. Rev Panam Salud Publica 2020;44: e72.
• Referans 26. Caricchio R, Gallucci M, Dass C, et al. Preliminary predictive criteria for COVID-19 cytokine storm. Ann Rheum Dis 2021; 80:88–95.
• Referans 27. Yang A-P, Liu J-P, Tao W-Q, Li H-M. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Imunopharmacology 2020; 84:106504.
• Referans 28. Rizo-Téllez SA, Méndez-García LA, Flores-Rebollo C, et al. The Neutrophil-to-Monocyte Ratio and Lymphocyte-to-Neutrophil Ratio at admission predict in hospital mortality in Mexican patients with severe SARS-CoV-2 infection (Covid-19). Microorganisms. 2020;8(10):1560.
• Referans 29. Zhang H, Cao X, Kong M, et al. Clinical and hematological characteristics of 88 patients with COVID-19. Int J Lab Hematol 2020; 42:780–7.
• Referans 30. Bal T, Dogan S, Cabalak M, Dirican E. Lymphocyte-to-C-reactive protein ratio may serve as an effective biomarker to determine COVID-19 disease severity. Turkish J Biochem 2021; 46:21–6.
• Referans 31. Nalbant A, Demirci T, Kaya T, et al. Can prognostic nutritional index and systemic immune‐inflammatory index predict disease severity in COVID‐19? Int J Clin Pract. 2021;75(10): e14544.
• Referans 32. Gumus H, Demir A, Yükkaldıran A. Is mean platelet volume a predictive marker for the diagnosis of COVID‐19 in children? Int J Clin Pract Pract. 2021;75(4): e13892.
• Referans 33. Bongomin F, Asio LG, Ssebambulidde K, Baluku JB. Adjunctive intravenous immunoglobulins (IVIg) for moderate-severe COVID-19: emerging therapeutic roles. Curr Med Res Opin 2021; 37:903–5.
• Referans 34. Nissen CB, Sciascia S, de Andrade D, et al. The role of antirheumatics in patients with COVID-19. Lancet Rheumatol. 2021;3: e447–e59.
• Referans 35. Cicha A, Fischer MB, Wesinger A, et al. Effect of intravenous immunoglobulin administration on erythrocyte and leucocyte parameters. J Eur Acad Dermatology Venereol 2018; 32:1004–10.
• Referans 36. McKay LI, Cidlowski JA. Physiologic and pharmacologic effects of corticosteroids. In: Kufe DW, Pollock RE, Weichselbaum RR, et al (eds) Holland-Frei Cancer Medicine, 2003 6th ed. BC Decker Hamilton.
• Referans 37. Liu X, Cao W, Li T. High-Dose Intravenous immunoglobulins in the treatment of severe acute viral pneumonia: The known mechanisms and clinical effects. Front Immunol. 2020; 11:1660.
• Referans 38. Artero A, Zaragoza R, Camarena JJ, et al. Prognostic factors of mortality in patients with community-acquired bloodstream infection with severe sepsis and septic shock. J Crit Care 2010; 25:276–281
• Referans 39. Wolthers T, Hamberg O, Grøfte T, Vilstrup H. Effects of budesonide and prednisolone on hepatic kinetics for urea synthesis. J Hepatol 2000; 33:549–54.