Introduction
Methods
Patients
Clinical and laboratory evaluation
Case definition and classification
Statistical analysis
Results
Study population and disease classification
Patient demographics and characteristics
Active COVID-19 Pneumonia (N = 16) | Moderate COVID-19 Pneumonia (N = 8) | Severe COVID-19 Pneumonia (N = 8) | MIS-C (N = 21) | Mild MIS-C (N = 10) | Severe MIS-C (N = 11) | Total vs Total | Severe vs Severe | |
---|---|---|---|---|---|---|---|---|
Age - years (IQR | ||||||||
Median | 15.5 (8.75–17.25) | 15.5 (12.75–16.25) | 13 (2.25–18.25) | 12 (8–13) | 10 (8–12.75) | 12 (11–13) | 0.1010 | 0.7726 |
Gender - no. (%) | ||||||||
Male | 11 (69) | 6 (75) | 5 (62.5) | 12 (57) | 4 (40) | 8 (73) | 0.5154 | 1.0000 |
Race - no. (%) | ||||||||
White | 4 (25) | 0 (0) | 4 (50) | 6 (29) | 3 (30) | 3 (27) | – | – |
Black | 9 (56) | 6 (75) | 3 (37.5) | 11 (52) | 5 (50) | 6 (55) | – | – |
Other | 3 (19) | 2 (25) | 1 (12.5) | 4 (19) | 2 (20) | 2 (18) | – | – |
Ethnicity - no. (%) | ||||||||
Hispanic | 3 (19) | 2 (25) | 1 (12.5) | 4 (19) | 2 (20) | 2 (18) | – | – |
Non-Hispanic | 13 (81) | 6 (75) | 7 (87.5) | 17 (81) | 8 (80) | 9 (82) | – | – |
Previously Healthy - no. (%) | ||||||||
Yes | 1 (6) | 0 (0) | 1 (12.5) | 19 (90) | 9 (90) | 10 (91) | < 0.00001 | 0.0012 |
Underlying Conditions - no. (%) | ||||||||
Any | 15 (94) | 8 (100) | 7 (87.5) | 2 (10) | 1 (10) | 1 (9) | – | – |
Obesity | 6 (37.5) | 5 (62.5) | 1 (12.5) | 0 (0) | 0 (0) | 0 (0) | – | – |
Asthma | 4 (25) | 3 (37.5) | 1 (12.5) | 2 (10) | 1 (10) | 1 (9) | – | – |
Chronic Lung Disease | 1 (6) | 0 (0) | 1 (12.5) | 0 (0) | 0 (0) | 0 (0) | – | – |
Cancer | 2 (12.5) | 2 (25) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | – | – |
Autoimmune Disease | 1 (6) | 0 (0) | 1 (12.5) | – | – | |||
Diabetes | 2 (12.5) | 1 (12.5) | 1 (12.5) | 0 (0) | 0 (0) | 0 (0) | – | – |
Congenital Heart Disease | 2 (12.5) | 0 (0) | 2 (25) | 0 (0) | 0 (0) | 0 (0) | – | – |
Neurodevelopmental Dx | 5 (31) | 0 (0) | 5 (62.5) | 0 (0) | 0 (0) | 0 (0) | – | – |
Presentation and SARS-CoV-2 testing
Active COVID-19 Pneumonia (N = 16) | Moderate COVID-19 Pneumonia (N = 8) | Severe COVID-19 Pneumonia (N = 8) | MIS-C (N = 21) | Mild MIS-C (N = 10) | Severe MIS-C (N = 11) | Total vs Total | Severe vs Severe | |
---|---|---|---|---|---|---|---|---|
Symptoms on Presentation - no. (%) | ||||||||
Fever | 12 (75) | 7 (87.5) | 5 (62.5) | 21 (100) | 10 (100) | 11 (100) | 0.0276 | 0.0578 |
Respiratory Symptoms | 14 (87.5) | 6 (75) | 8 (100) | 1 (5) | 1 (10) | 0 (0) | < 0.00001 | < 0.00001 |
Hypoxia | 7 (44) | 1 (12.5) | 6 (75) | 0 (0) | 0 (0) | 0 (0) | 0.0011 | 0.0010 |
Cough | 7 (44) | 5 (62.5) | 2 (25) | 0 (0) | 0 (0) | 0 (0) | 0.0011 | 0.1637 |
Shortness of Breath | 9 (56) | 4 (50) | 5 (62.5) | 1 (5) | 1 (10) | 0 (0) | 0.0001 | 0.0048 |
Gastrointestinal Symptoms | 6 (37.5) | 3 (37.5) | 3 (37.5) | 21 (100) | 10 (100) | 11 (100) | < 0.00001 | 0.0048 |
Nausea/Vomiting | 5 (31) | 2 (25) | 3 (37.5) | 15 (71) | 8 (80) | 7 (64) | 0.0220 | 0.3698 |
Diarrhea | 2 (12.5) | 2 (25) | 0 (0) | 11 (52) | 5 (50) | 6 (55) | 0.0165 | 0.0181 |
Abdominal Pain | 1 (6) | 1 (12.5) | 0 (0) | 12 (57) | 6 (60) | 6 (55) | 0.0016 | 0.0181 |
Rash | 0 (0) | 0 (0) | 0 (0) | 13 (62) | 7 (70) | 6 (55) | 0.0001 | 0.0181 |
Conjunctivitis | 0 (0) | 0 (0) | 0 (0) | 14 (67) | 8 (80) | 6 (55) | < 0.00001 | 0.0181 |
Mucosal Changes | 0 (0) | 0 (0) | 0 (0) | 4 (19) | 2 (20) | 2 (18) | 0.1182 | 0.4854 |
Length of symptoms prior to presentation - days (IQR) | ||||||||
Median duration of symptoms prior to presentation | 3 (1.75–6.25) | 3.5 (2.75–7) | 2 (1–3.75) | 4 (3–5) | 5 (3.25–5) | 4 (3–4.5) | 0.2902 | 0.2155 |
COVID-19 exposures | ||||||||
Known COVID-19 exposure - no. (%) | 8 (50) | 5 (62.5) | 3 (37.5) | 6 (29) | 4 (40) | 2 (18) | 0.3051 | 0.6027 |
Prior documented COVID-19 infection - no. (%) | N/A | N/A | N/A | 4 (19) | 2 (20) | 2 (18) | – | – |
Time between exposure/infection and admission - days (IQR) | 6 (4.25–7.75) | 7.5 (6.5–8) | 3.5 (3.25–3.75) | 29.5 (24.5–32) | 28 (14–31) | 31 (29.5–33) | 0.0201 | – |
Level of Admission - no. (%) | ||||||||
Intensive Care | 13 (81) | 5 (62.5) | 8 (100) | 12 (57) | 1 (10) | 11 (100) | – | – |
Acute Care | 3 (19) | 3 (37.5) | 0 (0) | 9 (43) | 9 (90) | 0 (0) | – | – |
Length of Stay – days (IQR) | 14 (6.75–28.25) | 9.5 (5.5–12.25) | 29.5 (21.75–47) | 5 (3–8) | 3.5 (3.25–5) | 7 (5.5–10) | 0.0008 | 0.0023 |
SARS-CoV-2 Positivity - no. (%) | ||||||||
PCR | 16 (100) | 8 (100) | 8 (100) | 8 (38) | 5 (50) | 3 (27) | 0.0001 | 0.0010 |
IgG Antibodies - no./total no. (%) | 0/0 (0) | 0/0 (0) | 0/0 (0) | 16/17 (94) | 8/9 (89) | 8/8 (100) | – | – |
Additional Infectious Agent - no. (%) | ||||||||
Viral | 1 (6) | 1 (12.5) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0.4324 | 1.0000 |
Bacterial | 3 (19) | 1 (12.5) | 2 (25) | 1 (5) | 1 (10) | 0 (0) | 0.2962 | 0.1637 |
Vasopressor Requirement - no. (%) | ||||||||
Yes | 5 (31) | 0 (0) | 5 (62.5) | 11 (52) | 0 (0) | 11 (100) | 0.3161 | 0.0578 |
No | 11 (69) | 8 (100) | 3 (37.5) | 10 (48) | 10 (100) | 0 (0) | – | – |
Respiratory Support - no. (%) | ||||||||
None | 0 (0) | 0 (0) | 0 (0) | 8 (38) | 7 (70) | 1 (9) | 0.0056 | 1.0000 |
Low Flow Oxygen | 5 (31) | 5 (62.5) | 0 (0) | 5 (24) | 2 (20) | 3 (27) | 0.7165 | 0.2281 |
High Flow Oxygen | 3 (19) | 3 (37.5) | 0 (0) | 2 (10) | 1 (10) | 1 (9) | 0.6339 | 1.0000 |
Positive pressure ventilation | 8 (50) | 0 (0) | 8 (100) | 6 (29) | 0 (0) | 6 (55) | 0.3051 | 0.0445 |
Laboratory findings
Active COVID-19 Pneumonia (N = 16) | Moderate COVID-19 Pneumonia (N = 8) | Severe COVID-19 Pneumonia (N = 8) | MIS-C (N = 21) | Mild MIS-C (N = 10) | Severe MIS-C (N = 11) | Total vs Total | Severe vs Severe | |
---|---|---|---|---|---|---|---|---|
Laboratory findings on admission - no. (%) | ||||||||
Acute kidney injury | 5 (31) | 3 (37.5) | 2 (25) | 8 (38) | 2 (20) | 6 (55) | 0.7386 | 0.3521 |
Elevated liver enzymes | 12 (75) | 7 (87.5) | 5 (62.5) | 13 (62) | 5 (50) | 8 (73) | 0.4912 | 1.0000 |
Lymphopenia | 9 (56) | 4 (50) | 5 (62.5) | 14 (67) | 6 (60) | 8 (73) | 0.7332 | 1.0000 |
Thrombocytopenia | 3 (19) | 0 (0) | 3 (37.5) | 5 (24) | 1 (10) | 4 (36) | 1.0000 | 1.0000 |
Laboratory values on admission - median value (IQR) | ||||||||
Sodium (mmoL/L) | 139 (136.75–141.25) | 137.5 (135.75–138.25) | 141.5 (139.75–142.25) | 133 (131.75–134.25) | 134 (133–136.5) | 132 (130.3–133) | 0.0004 | 0.0059 |
Creatinine (mg/dL) | 0.78 (0.52–1.14) | 0.73 (0.56–0.99) | 0.78 (0.38–1.39) | 0.79 (0.59–0.89) | 0.6 (0.57–0.76) | 0.83 (0.77–1.24) | 0.9390 | 0.5357 |
Albumin (g/dL) | 3.7 (3.25–4.15) | 4 (3.7–4.3) | 3.3 (3.05–3.7) | 3.4 (3–3.6) | 3.6 (3.25–3.68) | 3 (2.6–3.5) | 0.0821 | 0.2898 |
Alanine transaminase (U/L) | 37.4 (18.8–58.05) | 55.05 (23.33–153.13) | 28.55 (16.4–44.03) | 42.4 (20.9–65.35) | 34.3 (15.2–52.8) | 52.2 (27.73–73.6) | 0.9746 | 0.1309 |
Aspartate transaminase (U/L) | 54.5 (33.75–115.25) | 60.5 (48–126.25) | 44.5 (27.25–70.25) | 43 (25.75–56.25) | 34 (24.25–46) | 43.5 (36.25–56.75) | 0.2791 | 0.6251 |
Brain znatriuretic peptide (pg/mL) | 46.85 (27.25–111.375) | 10 (10–31.7) | 101.4 (39.85–1281.85) | 642.5 (47.1–1129.15) | 40.75 (10–101.6) | 1004.95 (229.5–1778.5) | 0.7353 | 0.6184 |
Troponin (ng/mL) | 0.01 (0.01–0.02) | 0.01 (0.01–0.02) | 0.02 (0.01–0.05) | 0.1 (0.02–1.4) | 0.01 (0.01–0.07) | 0.24 (0.03–2.17) | 0.3194 | 0.2689 |
C-reactive protein (mg/dL) | 4.6 (1.41–11.11) | 3.62 (1.27–4.95) | 9.2 (1.43–11.9) | 15.93 (11.17–23.1) | 14 (6.21–18.14) | 17.73 (11.98–27.62) | 0.0015 | 0.0057 |
Erythrocyte sedimentation rate (mm/hr) | 25 (9–40) | 29.5 (13–38.5) | 19 (12.5–35) | 48 (38–58) | 49.5 (40.75–59.25) | 41 (38–58) | 0.0031 | 0.0097 |
Procalcitonin (ng/mL) | 0.77 (0.37–2.65) | 0.37 (0.18–3.28) | 1.32 (0.77–2.61) | 11.51 (4.35–24.41) | 2.18 (1.90–2.45) | 13.51 (8.41–31.96) | 0.0004 | 0.0013 |
White blood cell count (10^3/uL) | 9.95 (4.54–13.85) | 4.3 (2.39–7.39) | 11.44 (9.74–22.61) | 10.58 (8.44–12.78) | 10.82 (8.1–11.84) | 9.79 (8.88–14.92) | 0.4903 | 0.3218 |
Absolute lymphocyte count (10^3/uL) | 1.15 (0.59–1.42) | 1.15 (0.53–1.32) | 1.19 (0.83–1.51) | 0.84 (0.5–1.51) | 1.07 (0.91–1.75) | 0.5 (0.44–0.74) | 0.5774 | 0.1200 |
Hemoglobin (g/dL) | 12.1 (10.6–14.73) | 12.6 (11.35–14.78) | 11.7 (10.58–14.13) | 11.5 (10.4–11.9) | 11.55 (10.8–12.13) | 11.3 (10.1–11.8) | 0.1010 | 0.3020 |
Platelet count (10^3/uL) | 201 (164.75–263.5) | 226.5 (181.25–276) | 180.5 (77.25–239.5) | 190 (155–225) | 215 (165.75–271.3) | 180 (129.5–201) | 0.6567 | 0.9671 |
International normalized ratio | 1.1 (1.1–1.25) | 1.13 (1.08–1.17) | 1.1 (1.1–1.35) | 1.24 (1.18–1.4) | 1.15 (1.1–1.2) | 1.4 (1.22–1.4) | 0.0842 | 0.0877 |
Ferritin (ng/mL) | 472.6 (230.6–1982) | 472.6 (230.6–683.4) | 710.5 (246.55–1998.25) | 520.1 (282.5–789.1) | 461.9 (201.25–761.9) | 520.1 (370.7–1032.5) | 0.7632 | 0.9342 |
Lactate dehydrogenase (U/L) | 667 (462–818) | 767 (609.5–4861.5) | 647 (503.25–780.25) | 244 (200–299) | 271.5 (216–454.8) | 225 (184.5–264) | 0.0005 | 0.0049 |
D-dimer FEU (ug/mL) | 1.31 (0.61–1.94) | 1.18 (0.65–1.29) | 1.93 (1.21–2.03) | 2.51 (1.58–3.25) | 1.71 (1.37–2.35) | 3.15 (2.42–3.79) | 0.0236 | 0.0416 |
Fibrinogen (mg/dL) | 447 (312.5–594) | 529 (513–610) | 373 (260.25–500) | 544 (467–632) | 561.5 (424.75–633.3) | 489 (468.5–629) | 0.2114 | 0.0987 |
Echocardiography findings - no./total no. (%) | ||||||||
Decreased systolic function or ejection fraction | 1/7 (14) | 0/2 (0) | 1/5 (20) | 5/21 (24) | 1/10 (10) | 4/11 (36) | 1.0000 | 0.6000 |
Coronary artery dilation | 0/7 (0) | 0/2 (0) | 0/5 (0) | 7/21 (33) | 2/10 (20) | 5/11 (45) | 0.1414 | 0.1186 |
Z-score - median value (IQR) | N/A | N/A | N/A | 2.15 (2.12–2.92) | 2.12 (2.11–2.12) | 2.81 (2.15–3.03) | N/A | N/A |
Heart block | 0/7 (0) | 0/2 (0) | 0/5 (0) | 1/21 (5) | 0/10 (0) | 1/11 (9) | 1.0000 | 1.0000 |