tetano
Editor, Senior Moderator
Blood
. 2021 Apr 25;blood.2020010218.
doi: 10.1182/blood.2020010218. Online ahead of print.
Rate of thrombosis in children and adolescents hospitalized with COVID-19 or MIS-C
Hilary Baker Whitworth[SUP] 1 [/SUP], Sarah E Sartain[SUP] 2 [/SUP], Riten Kumar[SUP] 3 [/SUP], Katherine Armstrong[SUP] 4 [/SUP], Lance Ballester[SUP] 1 [/SUP], Marisol Betensky[SUP] 5 [/SUP], Clay Cohen[SUP] 2 [/SUP], Rosa Diaz[SUP] 6 [/SUP], Caroline Diorio[SUP] 1 [/SUP], Neil A Goldenberg[SUP] 7 [/SUP], Julie Jaffray[SUP] 8 [/SUP], Jacquelyn Keegan[SUP] 8 [/SUP], Kendra Malone[SUP] 9 [/SUP], Adrienne Randolph[SUP] 3 [/SUP], Stacey Rifkin-Zeneberg[SUP] 10 [/SUP], Wendy Seto Leung[SUP] 8 [/SUP], Anthony Alexander Sochet[SUP] 11 [/SUP], Lakshmi Srivaths[SUP] 12 [/SUP], Ayesha Zia[SUP] 13 [/SUP], Leslie Raffini[SUP] 1 [/SUP]
Affiliations
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is associated with thrombotic complications in adults, but the incidence of COVID-19 related thrombosis in children and adolescents is unclear. Most children with acute COVID-19 have mild disease, but coagulopathy has been associated with multisystem inflammatory syndrome in children (MIS-C), a post-infectious complication. We conducted a multicenter retrospective cohort study to determine the incidence of thrombosis in children hospitalized with COVID-19 or MIS-C and to evaluate associated risk factors. We classified patients into one of three groups for analysis: COVID-19, MIS-C, or asymptomatic SARS-CoV-2. Among a total of 853 admissions (426 COVID-19, 138 MIS-C, and 289 asymptomatic SARS-CoV-2) in 814 patients, there were 20 patients with thrombotic events (TE) (including 1 stroke). Patients with MIS-C had the highest incidence (6.5%, 9/138) versus COVID-19 (2.1%, 9/426) or asymptomatic SARS-CoV-2 (0.7%, 2/289). In patients with COVID-19 or MIS-C, the majority of thrombotic events (89%) occurred in patients ?12 years. Patients > 12 years with MIS-C had the highest rate of thrombosis at 19% (9/48). Notably, 71% of TE that were not present on admission occurred despite thromboprophylaxis. Multivariable analysis identified the following as significantly associated with thrombosis: age ?12 years, cancer, presence of a central venous catheter, and MIS-C. In patients with COVID-19 or MIS-C, hospital mortality was 2.3% (13/564), but was 28% (5/18) in patients with thrombotic events. Our findings may help inform pediatric thromboprophylaxis strategies.
. 2021 Apr 25;blood.2020010218.
doi: 10.1182/blood.2020010218. Online ahead of print.
Rate of thrombosis in children and adolescents hospitalized with COVID-19 or MIS-C
Hilary Baker Whitworth[SUP] 1 [/SUP], Sarah E Sartain[SUP] 2 [/SUP], Riten Kumar[SUP] 3 [/SUP], Katherine Armstrong[SUP] 4 [/SUP], Lance Ballester[SUP] 1 [/SUP], Marisol Betensky[SUP] 5 [/SUP], Clay Cohen[SUP] 2 [/SUP], Rosa Diaz[SUP] 6 [/SUP], Caroline Diorio[SUP] 1 [/SUP], Neil A Goldenberg[SUP] 7 [/SUP], Julie Jaffray[SUP] 8 [/SUP], Jacquelyn Keegan[SUP] 8 [/SUP], Kendra Malone[SUP] 9 [/SUP], Adrienne Randolph[SUP] 3 [/SUP], Stacey Rifkin-Zeneberg[SUP] 10 [/SUP], Wendy Seto Leung[SUP] 8 [/SUP], Anthony Alexander Sochet[SUP] 11 [/SUP], Lakshmi Srivaths[SUP] 12 [/SUP], Ayesha Zia[SUP] 13 [/SUP], Leslie Raffini[SUP] 1 [/SUP]
Affiliations
- PMID: 33895804
- DOI: 10.1182/blood.2020010218
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is associated with thrombotic complications in adults, but the incidence of COVID-19 related thrombosis in children and adolescents is unclear. Most children with acute COVID-19 have mild disease, but coagulopathy has been associated with multisystem inflammatory syndrome in children (MIS-C), a post-infectious complication. We conducted a multicenter retrospective cohort study to determine the incidence of thrombosis in children hospitalized with COVID-19 or MIS-C and to evaluate associated risk factors. We classified patients into one of three groups for analysis: COVID-19, MIS-C, or asymptomatic SARS-CoV-2. Among a total of 853 admissions (426 COVID-19, 138 MIS-C, and 289 asymptomatic SARS-CoV-2) in 814 patients, there were 20 patients with thrombotic events (TE) (including 1 stroke). Patients with MIS-C had the highest incidence (6.5%, 9/138) versus COVID-19 (2.1%, 9/426) or asymptomatic SARS-CoV-2 (0.7%, 2/289). In patients with COVID-19 or MIS-C, the majority of thrombotic events (89%) occurred in patients ?12 years. Patients > 12 years with MIS-C had the highest rate of thrombosis at 19% (9/48). Notably, 71% of TE that were not present on admission occurred despite thromboprophylaxis. Multivariable analysis identified the following as significantly associated with thrombosis: age ?12 years, cancer, presence of a central venous catheter, and MIS-C. In patients with COVID-19 or MIS-C, hospital mortality was 2.3% (13/564), but was 28% (5/18) in patients with thrombotic events. Our findings may help inform pediatric thromboprophylaxis strategies.