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. 2020 Sep;55(9):2354-2360.
doi: 10.1002/ppul.24907. Epub 2020 Jul 1.

Immune-related factors associated with pneumonia in 127 children with coronavirus disease 2019 in Wuhan

Yi Li  1 , Wenyue Deng  2 , Hao Xiong  1 , Hui Li  1 , Zhi Chen  1 , Yingming Nie  1 , Zhuo Wang  1 , Kaili Li  1 , Jianxin Li  1
Affiliations

Immune-related factors associated with pneumonia in 127 children with coronavirus disease 2019 in Wuhan

Yi Li et al. Pediatr Pulmonol. 2020 Sep.

Abstract

Objective: Information regarding the association of immune-related factors with pneumonia in children with coronavirus disease 2019 (COVID-19) is scarce. This study aims to summarize the immune-related factors and their association with pneumonia in children with COVID-19.

Methods: Children with COVID-19 at Wuhan Children's Hospital from 28 January to 12 March 2020 were enrolled. Pneumonia due to causes other than COVID-19 were excluded. The clinical and laboratory information including routine blood tests, blood biochemistry, lymphocyte subsets, immunoglobulins, cytokines, and inflammatory factors were analyzed retrospectively in 127 patients. Normal ranges and mean values of laboratory markers were applied as parameters for logistic regression analyses of their association with pneumonia.

Results: In nonintensive care unit patients, 48.8% and 22.4% of patients had increased levels of procalcitonin and hypersensitive C-reactive protein (hs-CRP) respectively. A total 12.6% and 18.1% of patients had decreased levels of immunoglobulin A (IgA) and interleukin 10 (IL-10), respectively. Approximately 65.8% of patients had pneumonia. These patients had decreased levels of globulin (odds ratio [OR], 3.13; 95% confidence interval [CI] 1.41-6.93; P = .005), IgA (OR, 4.00; 95% CI, 1.13-14.18; P = .032), and increased levels of hs-CRP (OR, 3.14; 95% CI, 1.34-7.36; P = .008), procalcitonin (OR, 3.83; 95% CI, 2.03-7.24; P < .001), IL-10 (OR, 7.0; 95% CI, 1.59-30.80; P = .010), and CD4+ CD25+ T lymphocyte less than 5.0% (OR, 1.93; 95% CI, 1.04-3.61; P = 0.038).

Conclusion: Decreased IgA and CD4+ CD25+ T lymphocyte percentage, and increased hs-CRP, procalcitonin, and IL-10 were associated with pneumonia, suggesting that the immune-related factors may participate in the pathogenesis of pneumonia in children with COVID-19.

Keywords: children; coronavirus disease 2019; cytokine; immunoglobulin; pneumonia.

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Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Dynamic changes in cytokines and ferritin in children with COVID‐19 admitted to the ICU. Shows temporal changes in the serum ferritin (A), plasma concentrations of interleukin 4 (B), interleukin 6 (C), interleukin 10 (D), tumor necrosis factor α (E), and interferon γ (F) in two patients with COVID‐19 admitted to the ICU (one nonsurvivor and one survivor). The solid blue lines show the upper normal limit of each parameter. The upper normal limit of interleukin 4 was not reached. COVID‐19, coronavirus disease 2019; ICU, intensive care unit [Color figure can be viewed at wileyonlinelibrary.com]
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