SARS-COV-2 infections in children: The role of fibrinogen in predicting diagnosis and severity: A retrospective cohort study

Background. Evaluating predictors of coronavirus disease 2019 (COVID-19) and severity among children may help clinicians manage the high rate of hospital admissions for suspected cases. Objectives. This study aimed to evaluate the demographic, clinical and laboratory characteristics of children during the pandemic, and determine the predictors of COVID-19 and moderate-to-severe disease. Materials and methods. This retrospective cohort study included all consecutive COVID-19 cases in patients aged <18 years who presented to the Pediatric Emergency Department at Haseki Training and Research Hospital (Istanbul, Turkey) between March 15 and May 1, 2020, and underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) analysis of oro-nasopharyngeal swabs (n = 1137). Results. The frequency of SARS-CoV-2 PCR positivity was 28.6%. The COVID-19 (+) group presented with sore throat, headache and myalgia significantly more frequently than the COVID-19 (-) group. Multivariate logistic regression models showed independent predictors of SARS-CoV-2 positivity as follows: age, contact history, lymphocyte count <1500/mm(3), and neutrophil count <4000/mm(3). In addition, higher age, neutrophil count and fibrinogen levels were independent predictors of severity. The diagnostic cutoff value for fibrinogen (370.5 mg/dL) had a sensitivity of 53.12, specificity of 83.95, positive predictive value (PPV) of 39.53, and negative predictive value (NPV) of 90.07 for predicting severity. Conclusions. Symptomatology, whether alone or in combination with other approaches, may be an appropriate strategy to guide the diagnosis and management of COVID-19.