Association of elevated D-dimers with severity and outcome of COVID-19 infection in children

Background : COVID-19 caused by novel coronavirus (SARS-CoV-2) resulted in global pandemic. In Pakistan, the first case was reported on 26th February 2020. Out of total confirmed cases, children and adolescents ≤20 years of age represented 10.6%. Hypercoagulability has been reported in COVID-19 infection. Multiple adult studies have highlighted relation of elevated D-dimers with disease severity. Aims : To determine association of D-dimers with the disease severity and outcome of children with COVID-19 and MIS-C/KD presenting to The Children's hospital, Lahore, Pakistan. Methods : This cross-sectional study was done at The Children's Hospital, Lahore, from March 15 to December 31, 2020. We analyzed data of all laboratory-confirmed pediatric cases of severe acute respiratory syndrome coronavirus infection and post-COVID MIS-C/KD admitted to the Corona ward. Results : Of 110 children, 73.6% were COVID and 26.4% post-COVID MIS-C/KD. 63.6% had mild-moderate illness followed by severe disease 21.8%. In 41% there was a pre-existing comorbidity, the most common of which was congenital heart and chronic kidney disease. The mean age was 7.03 ± 4.42 years with a male preponderance 58.2%. Fever (74.5%), respiratory (46.4%), and gastrointestinal symptoms (14.5%) were the predominant symptoms. Ddimers were done in 67 patients with the mean of 3.68 ± 2.08 μg/ml and a higher D-dimer value was significantly associated with severe and critical disease ( P = 0.001). D-dimer levels were high in MIS-C (4.61 ± 4.0 μg/ml) as compared to COVID (3.05 ± 4.6) ( P = 0.030). There were six deaths, comorbid conditions were associated with a fatal outcome in five cases and one death was due to MIS-C. A high D-dimer value was significantly associated with poor outcome ( P = 0.009). Conclusions : COVID-19 in children is generally mild with good outcome. A significant proportion of children presented with post-COVID MIS-C/KD. A high D-dimer value is significantly associated with severe disease and poor outcome. The presence of a co-morbid condition was a risk factor for poor outcome.