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As shown in Table 1, of 333 included patients with COVID-19, pediatric patients accounted for 9.9% (33/333) and adult patients accounted for 90.1% (300/333). The median age of adult patients was 47.0 (IQR, 33.0–66.0) years and of pediatric patients was 6 (IQR, 2.5–9.5) years. There were 51.5% female patients in total. No difference in sex was found between pediatric and adult patients (P = 0.451). One hundred and fifty (45.0%) patients had contacted with patients from Hubei province, 22 (6.6%) patients had contacted with patients from other provinces, 13 (3.9%) patients were residents of Shenzhen with no clear contact history, 122 (36.6%) patients were residents of Hubei province, and 26 (7.8%) patients had unknown contact history. There was difference in pandemic exposure (P = 0.025) between pediatric and adult patients. No cross-infection, medical staff infection or nosocomial infection occured in our center.
Clinical characteristics Count (%) P value* All patients (n = 333) Pediatric patients (n = 33) Adult patients (n = 300) Sex 0.451 Female 171 (51.4) 19 (57.6) 152 (50.7) Male 162 (48.6) 14 (42.4) 148 (49.3) Age, median (IQR) 47 (33.0–60.0) 6 (2.5–9.5) 50 (36.0–61.0) < 0.001 Epidemiological history 0.025 Contact with patients of Hubei province 150 (45.0) 23 (69.7) 127 (42.3) Contact with patients of other provinces 22 (6.6) 2 (6.1) 20 (6.7) Residents of Shenzhen with no clear contact history 13 (3.9) 0 (0.0) 13 (4.3) Residents of Hubei province 122 (36.6) 7 (21.2) 115 (38.3) Others 26 (7.8) 1 (3.0) 25 (8.3) Co-infection of other respiratory viruses (n = 323)† 0.014 No 317 (98.1) 29 (90.6) 288 (99.0) Yes 6 (1.9) 3 (9.4) 3 (1.0) Symptom onset to hospitalization, d (IQR) 3 (1.0–5.0) 1(1.0–1.0) 3 (2.0–6.0) < 0.001 Symptoms and signs Fever 257 (77.2) 11 (33.3) 246 (82.0) < 0.001 Cough 168 (50.5) 7 (21.2) 161 (53.7) < 0.001 Sputum 81 (24.3) 2 (6.1) 79 (26.3) 0.010 Dyspnea 15 (4.5) 1 (3.0) 14 (4.7) 1.000 Temperature, °C 0.078 < 37.3 215 (64.6) 28 (84.8) 187 (62.3) 37.3–38.0 86 (25.8) 4 (12.1) 82 (27.3) 38.1–39.0 31 (9.3) 1 (3.0) 30 (10.0) > 39.0 1 (0.3) 0 (0.0) 1 (0.3) Heart rate, median (IQR) 87 (80–96) 98 (88–114) 86 (79–95) < 0.001 Breathing rate, median (IQR) 20 (19–20) 22 (20–24) 20 (19–20) < 0.001 Systolic pressure, median (IQR), mmHg 125 (115.0–136.0) 103 (95.5–115.5) 126 (116.3–137.8) < 0.001 Severity < 0.001 Mild 33 (9.9) 13 (39.4) 20 (6.7) Moderate 271 (81.4) 20 (60.6) 251 (83.7) Severe and critical 29 (8.7) 0 (0.0) 29 (9.7) Underlying diseases 78 (23.4) 0 (0.0) 78 (26.0) 0.001 Hypertension 39 (11.7) 0 (0.0) 39 (13.0) 0.055 Diabetes 18 (5.4) 0 (0.0) 18 (6.0) 0.298 Heart disease 15 (4.5) 0 (0.0) 15 (5.0) 0.383 Chronic lung disease 11 (3.3) 0 (0.0) 11 (3.7) 0.545 Chronic liver disease 8 (2.4) 0 (0.0) 8 (2.7) 1.000 Malignant tumors 3 (0.9) 0 (0.0) 3 (1.0) 1.000 Cerebrovascular disease 2 (0.6) 0 (0.0) 2 (0.7) 1.000 Others 7 (2.1) 0 (0.0) 7 (2.3) 1.000 Note. Data are presented as n (%) and median (interquartile ranges, IQR).
*P values indicate differences between pediatric and adult patients. P < 0.05 was considered statistically significant.
†Number of patients for whom data were available.Table 1. Baseline clinical characteristics of COVID-19 patients
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Pediatric patients had higher rate of co-infection of other respiratory viruses (including: respiratory syncytial virus and influenza B virus) compared to adult patients (9.4% vs. 1.0%, P = 0.014). They also had a shorter time of symptom onset to hospitalization than adults [median time, 1 (IQR, 1.0–1.0) d vs. 3 (IQR, 2.0–6.0) d, P < 0.001]. Some symptoms such as fever (33.3% vs. 82.0%, P < 0.001), cough (21.2% vs. 53.7%, P < 0.001), and sputum (6.1% vs. 26.3%, P = 0.010), are rarer in children than in adults. There was a significant difference in clinical severity classification that children had lower grades than adults (children: 39.4% mild, 60.6% moderate, 0.0% severe and critical vs. adults: 6.7% mild, 83.7% moderate, 9.7% severe and critical, P < 0.001). Underlying diseases were reported only by adults, including 39 (13.0%) cases of hypertension, 18 (6%) cases of diabetes, 15 (5%) cases of heart disease, 11 (3.7%) cases of chronic lung disease, 8 (2.7%) cases of chronic liver disease, 3 (1%) cases of malignant tumors, 2 (0.7%) cases of cerebrovascular disease, and 7 (2.3%) cases of other underlying diseases.
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COVID-19 related laboratory examination data on admission were retrieved and summarized in Table 2. Compared with adult patients, pediatric patients had higher levels of white blood cell counts (P < 0.001), lymphocyte counts (P < 0.001), platelet counts (P < 0.001), aspartate aminotransferase (AST) (P = 0.001), alkaline phosphatase (ALP) (P < 0.001), lactic acid dehydrogenase (LDH) (P = 0.003), creatine kinase-MB (CK-MB) (P < 0.001), PaO2 (P < 0.001), PaO2/FiO2 (P < 0.001), T lymphocyte count (P < 0.001), CD4+ T lymphocytes counts (P < 0.001) and CD8+ T lymphocyte counts (P < 0.001). Compared with adult patients, pediatric patients had lower levels of hemoglobin (Hb) content (P = 0.001), total bilirubin (TBIL) (P = 0.001), alanine aminotransferase (ALT) (P = 0.017), gamma-glutamyltransferase (GGT) (P < 0.001), creatinin (Cr) (P < 0.001), C-reactive protein (CRP) (P < 0.001), interleukin 6 (IL-6) (P < 0.001), erythrocyte sedimentation rate (ESR) (P < 0.001), and arterial blood PH (P = 0.009). Chest CT imaging examination showed a significant difference between children and adults (Figure 1). In children, there were 13 (39.4%) cases with no obvious changes, 9 (27.3%) cases of unilateral lung lesions, and 11 (33.3%) cases of bilateral lung lesions; in adult patients, there were 20 (6.7%) cases with no obvious changes, 26 (8.7%) cases of unilateral lung lesions, and 254 (84.7%) cases of bilateral lung lesions. The results suggested that pediatric patients had milder or hidden lung lesions in the imaging findings (P < 0.001).
Figure 1. Chest computed tomographic iimages of pediatric patients and adult patients with coronavirus disease 2019 (COVID-19). (A) Chest CT showing unilateral lung lesions in children. (B) Chest CT showing bilateral lung lesions in children. (C) Chest CT showing unilateral lung lesions in adult. (D) Chest CT showing bilateral lung lesions in adult
Items Value (IQR) P value* All patients (n = 333) Pediatric patients (n = 33) Adult patients (n = 300) White blood cell count, × 109/L 4.6 (3.6−5.7) 5.6 (4.5−8.9) 4.5 (3.5−5.6) < 0.001 Neutrophil count, × 109/L 2.6 (1.9−3.5) 2.2 (1.4−3.8) 2.6 (1.9−3.5) 0.126 Lymphocyte count, × 109/L 1.3 (1.0−1.7) 2.5 (2.0−4.1) 1.2 (0.9−1.6) < 0.001 Hemoglobin, g/L 136 (126−146) 128 (123−138) 137 (127−147) 0.001 Platelet count, × 109/L 180 (143−224) 253 (214−322) 174 (141−209) < 0.001 Ferritin, pmol/L (n = 62) † 647.0 (258.9−883.7) 212.3 (155.5−835.3) (n = 5) † 658.7 (287.6−884.4) (n = 57) † 0.250 Total bilirubin, μmol/L 9.8 (7.6−14.6) 8.6 (5.3−11.0) 10.1 (7.8−15.2) 0.001 Alanine aminotransferase, U/L 20.0 (15.0−31.0) 16.0 (11.5−24.1) 21.0 (15.0−31.7) 0.017 Aspartate aminotransferase, U/L 27.0 (21.0−36.4) 38.0 (24.0−48.8) 26.0 (20.9−35.0) 0.001 Gamma-glutamyltransferase, U/L 24.0 (15.1−39.0) 12.8 (11.0−17.5) 26.0 (17.0−41.0) < 0.001 Alkaline phosphatase, U/L (n = 251) † 50.0 (50.0−78.0) 186.5 (154.0−222.8) (n = 24) † 59.0 (49.0−72.0) (n = 227) † < 0.001 Urea nitrogen, mmol/L 4.0 (3.2−4.9) 3.8 (3.1−4.8) 4.0 (3.2−5.0) 0.913 Creatinin, μmol/L 62.0 (49.9−75.2) 31.0 (26.0−38.4) 65.0 (53.0−78.0) < 0.001 C-Reactive protein, mg/L (n = 325) † 10.3 (3.9−27.4) 4.3 (0.5−5.5) (n = 31) † 12.4 (4.8−29.37) (n = 294) † < 0.001 Procalcitonin, ng/mL (n = 274) † 3.3 (0.1−5.3) 3.0 (0.1−5.7) (n = 27) † 3.3 (0.1−5.3) (n = 247) † 0.818 Interleukin 6, pg/mL (n = 231) † 10.7 (4.2−19.6) 3.3 (2.0−4.5) (n = 21) † 12.0 (5.0−21.4) (n = 210) † < 0.001 Erythrocyte sedimentation rate, mm/h
(n = 280) †30.0 (15.0−48.8) 10.0 (5.0−18.5) (n = 25) † 30.0 (15.0−50.0) (n = 255) † < 0.001 Lactic acid dehydrogenase (n = 296) † 223.0 (175.0−400.0) 278.0 (222.5−561.3) (n = 30) † 215.0 (170.0−387.3) (n = 266) † 0.003 cTnI, μg/L (n = 284) † 0.012 (0.012−6.000) 0.012 (0.012−6.000) (n = 30) † 0.012 (0.012−6.000) (n = 254) † 0.266 Creatine kinase-MB, ng/mL (n = 308) † 0.54 (0.22−1.07) 1.17 (0.40−2.85) (n = 32) † 0.52 (0.22−1.00) (n = 276) † < 0.001 Prothrombin time, s (n = 314) † 11.9 (11.3−12.5) 12.1 (11.6−11.7) (n = 31) † 11.8 (11.2−12.5) (n = 283) † 0.072 Activated partial thromboplastin time,
s (n = 316) †35.5 (32.5−38.7) 34.8 (33.0−38.9) (n = 31) † 35.6 (32.5−38.7) (n = 285) † 0.772 D-dimer, μg/mL (n = 313) † 0.37 (0.26−0.56) 0.31 (0.24−0.55) (n = 30) † 038 (0.26−0.56) (n = 283) † 0.261 pH (n = 316) † 7.42 (7.40−7.44) 7.39 (7.37−7.44) (n = 28) † 7.42 (7.40−7.44) (n = 288) † 0.009 PaCO2, mmHg (n = 317) † 39.0 (35.7−41.4) 38.8 (34.4−41.5) (n = 28) † 39.0 (36.0−41.4) (n = 289) † 0.340 PaO2, mmHg (n = 317) † 92.2 (79.1−106.0) 108.0 (103.3−124.0) (n = 28) † 90.5 (78.0−103.0) (n = 289) † < 0.001 PaO2 /FiO2, mmHg (n = 317) † 413 (355.0−476.5) 514 (491.3−585.3) (n = 28) † 401 (349.0−462.5) (n = 289) † < 0.001 T lymphocyte count,μL (n = 207) † 973 (627.0−1314.0) 1784.5 (1489.5−2857.8) (n = 22) † 894 (589.5−1191.0) (n = 185) † < 0.001 CD4 count, μL (n = 207) † 5,190 (344.0−714.0) 852 (740.8−1428.3) (n = 22) † 499 (335.5−652.5) (n = 185) † < 0.001 CD8 count, μL (n = 207) † 348 (207.0−515.0) 684 (593.8−1050.8) (n = 22) † 326 (194.5−439.5) (n = 185) † < 0.001 Lung lesions by CT < 0.001 None, n (%) 33 (9.9) 13 (39.4) 20 (6.7) Unilateral, n (%) 35 (10.5) 9 (27.3) 26 (8.7) Bilateral, n (%) 265 (79.6) 11 (33.3) 254 (84.7) Note. Data are presented as median (interquartile ranges, IQR) and n (%)
*P values indicate differences between pediatric and adult patients. P < 0.05 was considered statistically significant;
†Number of patients for whom data were available.Table 2. Summary on laboratory and radiographic data of COVID-19 patients
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All children and adult patients were treated under isolation and in accordance with the Chinese Programme for the Diagnosis and Treatment of Novel Coronavirus Infected Pneumonia[15]. Treatments for patients were summarize in Table 3. All patients received antiviral therapy (ribavirin, interferon, lopina veletonavir, favipiravir, abidal, or chloroquine), and 99 (29.7%) patients received antibiotics (cephalosporins, quinolones, and carbapenems), including 9.1% (3/33) of the pediatric patients and 32.0% (96/300) of the adult patients. Hormonal therapy was received by 30.0% (90/300) of the adult patients and gamma globulin therapy was received by 27.0% (81/300) of the adult patients. No pediatric patients received hormonal or gamma globulin therapy. A total of 18.2% (6/33) pediatric patients and 77.7% (233/300) adult patients received oxygen therapy (P < 0.001). Of pediatricpatients, 5 (15.2%) received nasal cannula and 1 (3.0%) received mask oxygen; of adult patients, 177 (59.0%) received nasal cannula, 6 (2.0%) received mask oxygen, 10 (3.3%) received high-flow oxygen, 24 (8.0%) received noninvasive ventilation, 14 (4.7%) received invasive ventilation, and 2 (0.7%) received extracorporeal membrane oxygenation (ECMO). Of all patients, only 3 (1.0%) adult patients received continuous renal replacement therapy because of acute renal injury. Complications occurred only in adults, and no complications occurred in children; 13 complications in adults included 2 case of acute heart injury (0.6%), 3 cases of acute kidney injury (0.9%), 1 case of acute liver injury (0.3%), and 13 cases (3.9%) of ARDS, including 3 patients with multiple complications.
Items Count (%) P value* All patients (n = 333) Pediatric patients (n = 33) Adults patients (n = 300) Treatment Antiviral 333 (100) 33 (100) 300 (100) NA Antibiotics 99 (29.7) 3 (9.1) 96 (32.0) 0.006 Hormonal therapy 90 (27.0) 0 (0.0) 90 (30.0) < 0.001 Gamma globulin therapy 81 (24.3) 0 (0.0) 81 (27.0) 0.001 Renal replacement therapy 3 (0.9) 0 (0.0) 3 (1.0) 1.000 Oxygen therapy < 0.001 None 94 (28.2) 27 (81.8) 67 (22.3) Nasal cannula 182 (54.7) 5 (15.2) 177 (59.0) Face mask 7 (2.1) 1 (3.0) 6 (2.0) High flow 10 (3.0) 0 (0.0) 10 (3.3) Non-invasive ventilation 24 (7.2) 0 (0.0) 24 (8.0) Invasive ventilation 14 (4.2) 0 (0.0) 14 (4.7) Invasive + ECMO 2 (0.6) 0 (0.0) 2 (0.7) Complication 13 (3.9) 0 (0.0) 13 (4.3) 0.455 Acute heart injury 2 (0.6) 0 (0.0) 2 (0.7) 1.000 Acute kidney injury 3 (0.9) 0 (0.0) 3 (1.0) 1.000 Acute liver injury 1 (0.3) 0 (0.0) 1 (0.3) 1.000 Acute respiratory distress syndrome 13 (3.9) 0 (0.0) 13 (4.3) 0.455 Note. Data are presented as n (%);
*P values indicate differences between pediatric and adult patients. P < 0.05 was considered statistically significant.Table 3. Treatment and complications in pediatric and adult patients
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As of the last follow-up time of 15th March 2020, 324 patients had recovered and been discharged, including 33 (100%) of pediatric patients and 292 (97.3%) of adult patients. Only 2 (0.7%) adult patients died, with an overall case fatality rate of 0.6%. Only 7 adult patients are still in hospital. The median length of hospital stay of 333 patients was 21 d (95% CI: 19.8–22.2) (Figure 2A). Pediatric patients had a median hospital stay of 19 (95% CI: 16.6–21.4) d and adult patients had a median length of hospital stay of 21 (95% CI: 19.9–22.1) d. Pediatric patients had a shorter length of hospital stay than adult patients (P = 0.024) (Figure 2B).
Comparison of Clinical Characteristics and Outcomes of Pediatric and Adult Patients with Coronavirus Disease 2019 in Shenzhen, China
doi: 10.3967/bes2020.124
- Received Date: 2020-04-25
- Accepted Date: 2020-07-24
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Key words:
- Coronavirus disease 2019 /
- Severe acute respiratory syndrome coronavirus 2 /
- Clinical characteristics /
- Pediatric patients
Abstract:
Citation: | WANG Fang, LAI Chang Xiang, HUANG Peng Yu, LIU Jia Ming, WANG Xian Feng, TANG Qi Yuan, ZHOU Xuan, XIAN Wen Jie, CHEN Rui Kun, LI Xuan, LI Zhi Yu, LIAO Li Qun, HE Qing, LIU Lei. Comparison of Clinical Characteristics and Outcomes of Pediatric and Adult Patients with Coronavirus Disease 2019 in Shenzhen, China[J]. Biomedical and Environmental Sciences, 2020, 33(12): 906-915. doi: 10.3967/bes2020.124 |