Immunoglobulin Levels in Children with COVID-19 and Impact on Hospital Admissions

Yıl 2023, Cilt: 49 Sayı: 3, 349 - 353, 31.12.2023

Nurhan Kasap , Onur İncealtın

https://doi.org/10.32708/uutfd.1380760

Öz

The Coronavirus Disease 2019 (COVID-19) pandemic has become a global health crisis. It has been determined that children can be infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) as severely as adults. In this study, we aimed to investigate the levels of immunoglobulins and their impact on hospital admissions in children diagnosed with COVID-19. The demographic characteristics, clinical symptoms, and laboratory results of 138 children diagnosed with COVID-19 who visited the hospital between January 2020 and December 2022 and had their immunoglobulin levels checked were analyzed retrospectively using medical records. 53% of the cases were female, 47% were male, and the median age was 9 years (0.6–17.8). The most common presenting symptoms were fever (52%), cough (45%), and gastrointestinal symptoms (9%). Low levels of IgG were found in 34.5% of the cases, IgA in 14%, and IgM in 21.6%. In those with low IgG, a decrease in IgA, IgM, and IgE levels was also observed (p<0.001). Patients with low IgG also had lower levels of hemoglobin, total cholesterol, and LDL (p=0.015, p=0.036, and p=0.006, respectively). The group with low IgM had a higher need for hospitalization than the normal group (p=0.045). No significant relationship existed between hospitalization status and gender, IgG, IgA, and IgE (p>0.05). It was determined that children with low IgA and IgM levels had a significant need for pediatric intensive care (p=0.049, p=0.011, respectively). Prolonged hospitalization (>15 days) did not have a statistically significant relationship with gender, IgG, IgA, IgM, and IgE (p>0.05). Children with hypogammaglobulinemia diagnosed with COVID-19 have higher mortality and intensive care admission rates than the general population. Our findings emphasize the importance of immunoglobulin levels in the routine evaluation of children with COVID-19 who present with hospitalization needs, consistent with the literature.

Anahtar Kelimeler

COVID-19, pediatric COVID-19, hypogammaglobulinemia

COVID-19 Olan Çocuklarda İmmunoglobulin Seviyeleri ve Hastane Başvuruları Üzerine Etkisi

Öz

Koronavirüs hastalığı-2019 (COVID-19) salgını tüm dünyada bir sağlık krizine dönüşmüştür. Çocukların da erişkinler kadar Şiddetli Akut Solunum Sendromu Coronavirüs 2 (SARS-CoV-2) ile enfekte olabildikleri belirlenmiştir. Bu çalışmada, COVID-19 saptanan çocuklarda bakılan immunoglobulin seviyelerini ve hastane başvurularındaki etkisini araştırmayı amaçladık. Ocak 2020 ve Aralık 2022 tarihleri arasında hastaneye başvuran COVID-19 saptanan, immunoglobulin seviyeleri bakılan 138 çocuk hastanın; demografik özellikleri, klinik belirtileri ve laboratuvar sonuçları retrospektif olarak tıbbi kayıtlardan elde edilerek analiz edildi. Olguların %53’ü kız, %47’si erkekti ve yaş ortancaları 9 yıl (0,6–17,8) idi. En sık başvuru semptomları ateş (%52), öksürük (%45) ve gastrointestinal belirtilerdi (%9). IgG %34.5’inde, IgA %14’ünde ve IgM %21.6’sında düşük seviyelerde bulundu. Düşük IgG bulunan hastalarda; IgA, IgM ve IgE seviyelerinde de azalma olduğu saptandı (p<0.001). Düşük IgG olanlarda hemoglobin, total kolesterol ve LDL seviyelerininde de düşüklük görüldü (p=0.015, p=0.036 ve p=0.006, sırasıyla). IgM düşüklüğü olan grupta, normal olan gruba kıyasla hastane yatış gereksinimi daha fazlaydı (p=0.045). Yatış durumu ile cinsiyet, IgG, IgA ve IgE arasında anlamlı ilişki yoktu (p>0,05). Düşük IgA ve IgM seviyeleri olanlarda anlamlı oranda çocuk yoğun bakım ihtiyacı oldugu saptandı (p=0.049, p=0.011, sırasıyla). Uzayan yatış durumu (>15 gün) ile cinsiyet, IgG, IgA, IgM ve IgE arasında istatistiksel olarak anlamlı ilişki yoktu (p>0,05). Hipogammaglobulinemi olan COVID-19 tanılı çocuk hastalarda, genel popülasyona göre mortalite ve yoğun bakım yatış oranlarının daha yüksek olduğu bilinmektedir. Bulgularımız, COVID-19 ile başvuran, hastane yatış gereksinimi olan çocuk hastaların rutin değerlendirmesinde immunoglobulin seviyelerinin değerlendirilmesinin önemini vurgulamaktadır.

Anahtar Kelimeler

COVID-19, çocuk COVID-19, hipogammaglobulinemi

Kaynakça

• 1. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. doi: 10.1001/jama.2020.5394.
• 2. Mai F, Del Pinto R, Ferri C. COVID-19 and cardiovascular diseases. J Cardiol. 2020;76(5):453-8. doi: 10.1016/j.jjcc.2020.07.013.
• 3. Tepasse PR, Hafezi W, Lutz M, Kuhn J, Wilms C, Wiewrodt R, et al. Persisting SARS-CoV-2 viraemia after rituximab therapy: two cases with fatal outcome and a review of the literature. Br J Haematol. 2020;190(2):185-8. doi: 10.1111/bjh.16896.
• 4. Hagin D, Freund T, Navon M, Halperin T, Adir D, Marom R, et al. Immunogenicity of Pfizer-BioNTech COVID-19 vaccine in patients with inborn errors of immunity. J Allergy Clin Immunol. 2021;148(3):739-49. doi: 10.1016/j.jaci.2021.05.029.
• 5. Tangye SG, Al-Herz W, Bousfiha A, Cunningham-Rundles C, Franco JL, Holland SM, et al. Human Inborn Errors of Immunity: 2022 Update on the Classification from the International Union of Immunological Societies Expert Committee. J Clin Immunol. 2022;42(7):1473-507. doi: 10.1007/s10875-022-01289-3.
• 6.Cassimos DC, Liatsis M, Stogiannidou A, Kanariou MG.Children with frequent infections: a proposal for a stepwise assessment and investigation of the immune system. Pediatr Allergy Immunol. 2010;21(3):463-73. doi: 10.1111/j.1399-3038.2009.00964.x.
• 7.Meyts I, Bucciol G, Quinti I, Neven B, Fischer A, Seoane E, etal. Coronavirus disease 2019 in patients with inborn errors ofimmunity: An international study. J Allergy Clin Immunol.2021;147(2):520-31. doi: 10.1016/j.jaci.2020.09.010.
• 8.Brown LK, Moran E, Goodman A, Baxendale H, Bermingham W, Buckland M, et al. Treatment of chronic or relapsing COVID-19 in immunodeficiency. J Allergy Clin Immunol. 2022;149(2):557-61 e1. doi: 10.1016/j.jaci.2021.10.031.
• 9.Grammatikos A, Donati M, Johnston SL, Gompels MM. Peripheral B Cell Deficiency and Predisposition to Viral Infections: The Paradigm of Immune Deficiencies. FrontImmunol. 2021;12:731643. doi: 10.3389/fimmu.2021.731643.
• 10.Scarpa R, Dell'Edera A, Felice C, Buso R, Muscianisi F, Finco Gambier R, et al. Impact of Hypogammaglobulinemia on the Course of COVID-19 in a Non-Intensive Care Setting: A Single-Center Retrospective Cohort Study. Front Immunol.2022;13:842643. doi: 10.3389/fimmu.2022.842643.
• 11.Jones JM, Faruqi AJ, Sullivan JK, Calabrese C, Calabrese LH.COVID-19 Outcomes in Patients Undergoing B Cell Depletion Therapy and Those with Humoral Immunodeficiency States: AScoping Review. Pathog Immun. 2021;6(1):76-103. doi: 10.20411/pai.v6i1.435.
• 12.Tezcan I, Berkel AI, Ersoy F, Sanal O. Sağlıklı Türk çocukları ve erişkinlerde turbidometrik yöntemle bakılan serum immunoglobulin düzeyleri. Çocuk Sağlığı ve Hastalıkları Dergisi 1996;39:649‐656. 1996.
• 13.Zaidi SZA, Zaidi FZ, AlShehry N, Zaidi ARZ, Zaidi SZ,Abdullah SM. Aging and therapy-relatedhypogammaglobulinemia causing pneumonia: An overlookedcurable entity in the chaotic COVID-19 pandemic. J Med Virol.2021;93(1):202-3. doi: 10.1002/jmv.26318.
• 14.Bucciol G, Tangye SG, Meyts I. Coronavirus disease 2019 in patients with inborn errors of immunity: lessons learned. Curr Opin Pediatr. 2021;33(6):648-56. doi: 10.1097/MOP.0000000000001062.
• 15.Quinti I, Lougaris V, Milito C, Cinetto F, Pecoraro A,Mezzaroma I, et al. A possible role for B cells in COVID-19? Lesson from patients with agammaglobulinemia. J Allergy Clin Immunol. 2020;146(1):211-3 e4. doi: 10.1016/j.jaci.2020.04.013.
• 16.Cekic S, Cicek F, Kilic SS. The Impact of the SARS-CoV-2Pandemic in PID Patients Receiving Ig Replacement Therapy. J Clin Immunol. 2021;41(4):733-7. doi: 10.1007/s10875-020-00958-5.
• 17.Babaha F, Rezaei N. Primary Immunodeficiency Diseases in COVID-19 Pandemic: A Predisposing or Protective Factor? Am J Med Sci. 2020;360(6):740-1. doi: 10.1016/j.amjms.2020.07.027.
• 18.Drzymalla E, Green RF, Knuth M, Khoury MJ, Dotson WD,Gundlapalli A. COVID-19-related health outcomes in people with primary immunodeficiency: A systematic review. Clin Immunol. 2022;243:109097. doi: 10.1016/j.clim.2022.109097.
• 19.Garkaby J, Willett Pachul J, Scott O, Abrego Fuentes L, VongL, Upton JEM, et al. Favorable outcome of COVID-19 inpediatric patients with primary immunodeficiency. Pediatr Allergy Immunol. 2023;34(3):e13928. doi: 10.1111/pai.13928.
• 20.Danieli MG, Piga MA, Paladini A, Longhi E, Mezzanotte C, Moroncini G, et al. Intravenous immunoglobulin as an important adjunct in the prevention and therapy of coronavirus 2019 disease. Scand J Immunol. 2021;94(5):e13101. doi: 10.1111/sji.13101.
• 21.Volk A, Covini-Souris C, Kuehnel D, De Mey C, Romisch J, Schmidt T. SARS-CoV-2 Neutralization in Convalescent Plasma and Commercial Lots of Plasma-Derived Immunoglobulin. BioDrugs. 2022;36(1):41-53. doi: 10.1007/s40259-021-00511-9.
• 22.Arabi YM, Arifi AA, Balkhy HH, Najm H, Aldawood AS,Ghabashi A, et al. Clinical course and outcomes of critically illpatients with Middle East respiratory syndrome coronavirus infection. Ann Intern Med. 2014;160(6):389-97. doi: 10.7326/M13-2486.