Clinical features and outcomes of patients with SARS-CoV-2-associated pneumonia.
Demographic, clinical, analytical, and radiological characteristics are shown in Table 1. Almost half (72/151, 48%) of all children in our series had underlying conditions, including: asthma, 29/144 (20%); immunosuppressive treatment, 22/151 (14%); chronic lung disease, 16/151 (11%); or heart disease, 15/151 (10%). Most children had fever 115/151 (76%) or cough 117/151 (77%) at admission, and 63/151 (42%) had dyspnea or work of breathing. Other features included rhinorrhea 61/151 (40%) or fatigue 40/151 (26%), and only 5/151 children (3%) had anosmia or dysgeusia. Of the 151 patients, 22 (15%) required admission to a PICU, during a median of 5 days (IQR 1–15). Most children (146/151, 97%) had a favorable clinical course and were discharged after improvement. However, 5/151 (3%) children died, and all had serious comorbidities: 3 had chronic lung disease (bronchopulmonary dysplasia, idiopathic interstitial pneumonia or pulmonary pathology due to spinal muscular atrophy), and 2 had immunosuppression due to hematological disease and bone marrow transplant.
Radiology and laboratory findings .
For the diagnosis of pneumonia, all patients underwent at least one chest X-ray. Upon admission, 151 patients presented with initial CXR alterations, with 64/151 (42%) presenting with consolidation and 87/151 (58%) showing other infiltrates, according to WHO classification. Only a few patients (6/151, 4%) presented with pleural effusion and in 4 of them (67%) thoracentesis was performed. Coinfection was demonstrated in only 5/151 (3%) cases: two cases of Staphylococcus aureus , one of S.pneumoniae (pneumococcal antigen in pleural fluid), and two due to rhinovirus and influenza virus (1/151, 0.6% each).
Full blood count (FBC) analysis revealed leukopenia (<5 × 109/L) in 41/142 (29%) cases, lymphocytopenia (<1.5 × 109/L) in 59/142 (42%), thrombocytopenia (<150 × 109/L) in 22/142 (15%) and anemia (hemoglobin <11.5 g/L) in 54/142 (38%) cases. Regarding inflammatory markers, CRP levels >20 mg/L were reported in 65/135 (48%) patients, and procalcitonin levels >0.5 ng/ml in 26/102 (25%), with 12/102 (12%) of the patients having levels >2 ng/ml. Regarding blood coagulation function, the D-dimer median was 699.5 µg/L (IQR 160.5–3402) and was increased in 62/96 (65%) of the patients. Other findings are shown in Table 1.