Evaluation of Electrocardiographic Changes and Laboratory Parameters in Pediatric COVID-19

Year 2020, Volume: 10 Issue: 4, 541 - 548, 15.12.2020

Pınar Dervişoğlu , Bahri Elmas , Öner Özdemir , Mehmet Fatih Orhan

https://doi.org/10.31832/smj.784180

Abstract

Objective: Cardiac involvement of Coronavirus 19 disease (COVID-19) may be reflected by electrocardiographic (ECG) changes. ECG changes that may occur in hospital admission for COVID-19 in children have not yet been fully evaluated.
Materials-Methods: We examined 83 children admitted to our hospital with proven COVID-19. A detailed clinical examination, 12-lead ECG and laboratory tests were recorded. And then all laboratory parameters were evaluated by age.
Results: P wave amplitude was normal in 77.1% and high in 22.9% of study population. There was a significant difference in white blood cell (WBC), lymphocyte, neutrophil, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), D-dimer values between the group with P wave amplitude normal and the high group. 13.3% of patients had first degree AV block and 86.7% did not. There was a significant difference between the groups in WBC, lymphocyte, D-dimer, AST values. In our study, there was right ventricular hypertrophy (RVH) in the ECG of 17 cases. There was a significant difference in WBC, lymphocyte, D-dimer, LDH, AST values between groups with and without RVH. In addition, there were positive correlations among V1R, V6S, V1 R / S ratio and WBC, lymphocyte, D-dimer, creatinine kinase (CK), creatinine kinase isoform MB (CK-MB), LDH, AST values.
Conclusions: Pathological ECG findings were associated with laboratory values used in the course of the disease. We think that ECG is a test in the course of COVID-19 in children, which may make important contributions to clinicians to manage the patients when interpreted correctly.

Keywords

Child, COVID-19, electrocardiography

Pediyatrik COVID-19'da Elektrokardiyografi Değişiklikleri ve Laboratuvar Parametrelerinin Değerlendirilmesi

Abstract

Amaç: Koronavirüs 19 hastalığının (COVID-19) kardiyak tutulumu elektrokardiyografik (EKG) değişikliklerle yansıtılabilir. Çocuklarda COVID-19 nedeniyle hastane başvurularında meydana gelebilecek EKG değişiklikleri henüz tam olarak değerlendirilmemiştir.
Gereç ve Yöntemler: Kanıtlanmış COVID-19 tanısı ile hastaneye başvuran 83 çocuk değerlendirildi. Ayrıntılı klinik muayene, 12 derivasyonlu EKG ve laboratuvar testleri kaydedildi. Tüm laboratuvar değerleri yaşa göre değerlendirildi.
Bulgular: P dalga amplitüdü çalışma popülasyonunun% 77.1'inde normal ve% 22.9'unda yüksek bulundu. P dalga amplitüdü normal olan grup ile yüksek grup arasında beyaz kan hücresi (WBC), lenfosit, nötrofil, aspartat aminotransferaz (AST), laktat dehidrojenaz (LDH), D-dimer değerlerinde anlamlı fark vardı. Hastaların % 13.3'ünde birinci derece AV blok varken % 86.7'sinde yoktu. Birinci derece AV blok olan ve olmayan gruplar arasında WBC, lenfosit, D-dimer, AST değerlerinde anlamlı fark vardı. Çalışmamızda 17 olgunun EKG'sinde sağ ventrikül hipertrofisi (RVH) vardı. RVH olan ve olmayan gruplar arasında WBC, lenfosit, D-dimer, LDH, AST değerlerinde anlamlı farklılık vardı. Ayrıca V1R, V6S, V1 R / S oranı ile WBC, lenfosit, D-dimer, kreatinin kinaz (CK), kreatinin kinaz izoform MB (CK-MB), LDH, AST değerleri arasında pozitif korelasyon saptandı.
Sonuç: Patolojik EKG bulguları hastalığın seyrinde kullanılan laboratuvar değerleri ile ilişkilendirildi. EKG’nin çocuklarda COVID-19 seyrinde çok önemli bir test olduğunu ve doğru yorumlandığında klinisyenlerin hasta yönetimlerine ciddi katkılar sağlayabileceğini düşünüyoruz.

Keywords

Çocuk, COVID-19, elektrokardiyografi

References

• 1. Wu Z, Mcgoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA, 2020,5:13.24-32 PMID: 32091533 doi: 10.1001/jama.2020.2648.
• 2. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F et al. Association of cardiac injury with mortality in hospitalized. JAMA Cardiol. 2020, 5:802-10. doi: 10.1001/jamacardio.2020.0950.
• 3. Myung K. Park MD, FAAP, FACC and Mehrdad Salamat MD, FAAP, FACC. Electrocardiography. Park's Pediatric Cardiology for Practitioners, 2020,3,31-49.
• 4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020, 395:497-506. doi: 10.1016/S0140-6736(20)30183.
• 5. Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan G et al. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020, 95,6:E131-E134. doi: 10.1002/ajh.25774.
• 6. Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, Ma CL et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020 368:m606. PMID: 32075786.
• 7. Lippi G, Plebani M. The critical role of laboratory medicine during coronavirus disease 2019 (COVID19) and other viral outbreaks. Clin Chem Lab Med. 2020, 58,7:1063-1069. doi: 10.1515/cclm-2020-0240.
• 8. Huijing Ma, Jiani Hu , Jie Tian, Zhou X, Laws MT, Wesemann LD et al. A Single-Center, Retrospective Study of COVID-19 Features in Children: A Descriptive Investigation. BMC Med. 2020, 18,1:123. doi:10.1186/s12916-020-01596-9.
• 9. Zheng F, Liao C, Fan QH, Chen H, Zhou X, Xie Z et al. Clinical characteristics of children with coronavirus disease 2019 in Hubei, China. Curr Med Sci. 2020. 40,2:1-6 doi:10.1007/s11596-020-2172-6.
• 10. Guan WJ, Ni ZY, Hu Y, Liang W, Ou C, He J et al. Clinical characteristics of 2019 novel coronavirus infection in China. NEJM. 2020. PMID: 32109013 doi:10.1056/NEJMoa2002032.
• 11. Henry BM, Lippi G, Plebani M. Laboratory abnormalities in children with novel coronavirus disease. Clin Chem Lab Med. 2020,58,7:1135-1138. doi: 10.1515/cclm-2020-0272 .
• 12. Steven Douedi, Hani Douedi . P wave. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing ve 31869099, 2020 Jan. PMID: 31869099.
• 13. Bitnun A, Allen H, Heurter H, King SM, Opavsky MA, Ford-Jones E et al. Children hospitalized with severe acute respiratory syndrome-related illness in Toronto. Pediatrics. 2003 112,4:e261. doi: 10.1542/peds.112.4.e261.
• 14. Xiong H.F, Wang L, Li X.H. Clinical features of 31 children's SARS cases in Beijing. Chinese journal of pediatrics 41,8:574-7. PMID: 14744375.
• 15. Duan H.M., Shen K.L. Study on the relationship between characteristics and immunity of SARS in children. China Pediatr Emerg Med. 2006,13,3:281–282.
• 16. Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J et al. Clinical and Biochemical Indexes From 2019-nCoV Infected Patients Linked to Viral Loads and Lung Injury. Sci China Life Sci. 2020,9,63,3:364-374. doi: 10.1007/s11427-020-1643-8.
• 17. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T et al. Cardiovascular implications of fatal outcomes of patients. JAMA Cardiol. 2020 Mar 27, 5,7:1-8 doi: 10.1001/jamacardio.2020.1017.