Abstract
Objectives: We aimed to study the outcomes, severity, and seroconversion post SARS-CoV-2 infection in immunocompromised children and adolescents treated at our center.
Method: For this observational study, all pediatric patients who had COVID-19 infection from Sep-22-2020 to Nov-10-2021were identified by reviewing our laboratory records. Their charts were reviewed to determine clinical severity and outcome. Blood samples were drawn for anti-SARS-CoV-2 antibody assay. Serious COVID-19 infection (SVI) was defined if the patient had moderate, severe, or critical illness. A cutoff of 100 U/mL anti-SARS-CoV-2 antibodies was used to categorize low and high titer seroconversion.
Results: We identified 263 pediatric patients with COVID-19; most (68%) were symptomatic: 5% had severe or critical infection, 25% were hospitalized, 12 required respiratory support, 12 were admitted to the ICU, and five patients (2%) died. Multivariable analysis revealed several factors that predict SVI: Age above 12 years (p=0.035), body mass index above 95 th percentile (p=0.034), comorbid conditions (p=0.025), absolute neutrophil count ≤500(p=0.014) and absolute lymphocyte count ≤300 (p=0.022). Levels of anti-SARS-CoV-2 spike antibodies were obtained for 173 patients at a median of 94 days (range, 14-300) after PCR diagnosis; of them 142 (82%) patients seroconverted; the lowest seroconversion rate was observed in patients with hematological malignancies (79%). Our univariable model showed that the following factors were predictive of low titer: lower ANC, p=0.01; hematologic malignancy, p=0.023; receiving steroids in the last 14 days, p=0.032; time since last chemotherapy or immunosuppressive therapy less than 30 days, p=0.002; and being on active chemotherapy in the last 3 months prior to infection, p<0.001.
Conclusions: SARS-CoV-2 antibodies developed in most immunocompromised patients with COVID-19 infection in our study. Mortality was relatively low in our patients. Our univariable and multivariable models showed multiple variables that predict severity of infections and antibody response post COVID-19 infection. These observations may guide choice of active therapy during infection and the best timing of vaccination in this high-risk population.
Keywords: COVID 19; SARS-CoV-2; cancer; chemotherapy; children; immunocompromised; seroconversion; stem cell transplant.
【저자키워드】 SARS-CoV-2, children, Cancer, Chemotherapy, COVID 19, Seroconversion, Immunocompromised, stem cell transplant., 【초록키워드】 vaccination, therapy, Hospitalized, antibody, Hematological malignancy, SARS-COV-2 infection, severity, Antibody Response, Infection, outcome, anti-SARS-CoV-2, ICU, Immunocompromised patient, Laboratory, COVID, outcomes, body mass index, PCR, SARS-CoV-2 antibody, anti-SARS-CoV-2 antibody, COVID-19 infection, Patient, Critical, moderate, patients, predict, Clinical severity, Absolute lymphocyte count, high-risk population, Analysis, Hematologic malignancy, Respiratory Support, immunosuppressive, steroid, Predictive, observation, Factor, Pediatric patient, blood sample, Cutoff, seroconversion rate, Severity of infection, absolute neutrophil count, multivariable model, variable, FIVE, Cell, lowest, defined, was used, died, the patient, required, receiving, median, treated, less, determine, Level, ANC, comorbid condition, univariable, with COVID-19, 【제목키워드】 Infection, predict, Factor, Severity of infection, with COVID-19,