Ispitivanje specifičnosti kovid-19 infekcije kod dece i uticaja bolesti na kvalitet života

Abstract

UVOD: Kovid-19 je bolest uzrokovana SARS-CoV-2, a koja je prvi put registrovana decembra 2019. godine u Kini. Svetska zdravstvena organizacija je februara 2020. godine proglasila pandemiju kovid-19. Deca ređe obolevaju od kovid-19 u odnosu na odrasle, uglavnom se inficiraju kapljičnim putem u domaćinstvu od članova porodice, imaju blažu kliničku sliku i bolju prognozu bolesti. Neselektivna upotreba antimikrobnih lekova u lečenju obolele dece predstavljala je jedan od glavnih problema tokom pandemije. S obzirom na to da je kovid-19 infekcija pretnja svetskih razmera, pored uticaja na zdravstveno stanje, uočen je i uticaj na kvalitet života obolele dece. CILJ: Ciljevi istraživanja bili su: ispitati demografske karakteristike dece obolele od kovida-19, kao i prisustvo prethodnih hroničnih oboljenja; proceniti karakter i stepen težine kliničkih simptoma i znakova kovida-19 kod dece u različitim uzrasnim grupama; ispitati stepen zasićenosti hemoglobina kiseonikom, laboratorijske karakteristike, radiografski nalaz i kompjuterizovanu tomografiju grudnog koša kod dece sa infekcijom SARS-CoV-2; proceniti terapijske protokole i prediktore za primenu i dužinu trajanja antimikrobne terapije; proceniti kvalitet života dece dve godine nakon preležane infekcije SARS-CoV-2. METOD: Prospektivna kohortna studija je sprovedena u Kliničko-bolničkom centru „Dr D. Mišović – Dedinje“, nacionalnom centru za lečenje dece obolole od kovida-19. Prvo je sprovedena studija preseka, u okviru koje su regrutovani ispitanici za longitudinalno praćenje. Istraživanje je uključilo svu decu sa dokazanom infekcijom SARS-CoV-2 (N = 127), koja su hospitalizovana u periodu od 6. marta do 31. maja 2020. godine (prvi talas pandemije u Srbiji). Demografski, klinički i laboratorijski podaci su prikupljani iz medicinske dokumentacije. Dve godine nakon preležane infekcije, procenjivan je kvalitet života kod 81 deteta pomoću KINDL upitnika. REZULTATI: Prosečan uzrast ispitanika je bio 7,9 ± 5,5 godina. Većina (95%) dece je imala kontakt sa kovid-19 pozitivnim ukućanima. Najčešći simptomi i znaci kod dece obolele od kovida-19 bili su: povišena telesna temperatura (45,7%), tahikardija (29,1%) i kašalj (26,8%). Zapaljenje pluća je registrovano kod 1/4 ispitanika, neutropenija i limfocitoza kod više od polovine ispitanika, povišene koncentracije C-reaktivnog proteina (CRP) (> 10 mg/L) kod 4%, a parametri oštećenja jetre kod 20% obolelih. Antimikrobna terapija je primenjivana kod 47,2% ispitanika, a najveći broj dece je primao azitromicin (37,8%) i ceftriakson (22,8%). Najvažniji prediktori upotrebe antimikrobnih lekova bili su povišena telesna temperatura (UO 4,32; 95% CI: 1,77, 10,56; p = 0,001) i radiografski nalaz zapaljenja pluća (UO 7,42; 95% CI: 2,52, 21,83; p = 0,001). Sva deca sa aktivnom hroničnom bolešću (N = 4) su imala pneumoniju sa potrebom za antimikrobnim lekovima, od čega je dvoje dece je bilo na terapiji dodatnim kiseonikom, a kod jednog ispitanika sa varijantom Guillan-Barré sindroma bila je potrebna primena mehaničke ventilacije. Prediktori upotrebe većeg broja antimikrobnih lekova kod dece uzrasta 1–5 godina bili su muški pol (B = -0,65; 95% CI: -1,17, -0,13; p = 0,018), odsustvo kovida-19 u porodici (B = -1,38, 95% CI: -2,43, -0,34; p = 0,011), povišena koncentracija CRP-a (B = 0,12; 95% CI: 0,07, 0,17; p = 0,001) i radiografski verifikovana pneumonija (B = 0,81; 95% CI: 0,34, 1,29; p = 0,002). Navedene varijable i febrilnost na prijemu (B = 3,20; 95% CI: 1,03, 5,37; p = 0,006), bili su značajni prediktori dužeg trajanja antimikrobnog lečenja...

BACKGROUND: COVID-19 is an infectious disease caused by the SARS-CoV-2, registered in December 2019 in China for the first time. In February 2020, the World Health Organization declared the COVID-19 pandemic. Compared to adults, children get affected less often, they are mostly infected from family members, have milder clinical manifestations and better prognosis. Misuse of antibiotics to treat children with COVID-19 is one of the major issues during the pandemic. Because COVID-19 poses a global threat to health of children, their quality of life may be affected as well. OBJECTIVES: The objectives of the research were: to examine the demographic characteristics of children with COVID-19, as well as the presence of previous chronic diseases; to evaluate clinical manifestations of COVID-19 in children in different age groups; to examine oxygen saturation level, laboratory characteristics, radiographic and computed tomography findings in children with SARS-CoV-2 infection; to investigate therapeutic protocols and predictors for the antibiotic treatment; to evaluate the quality of life in children two years after the recovery from SARS-CoV-2 infection. METHODS: A prospective cohort study was conducted at the Clinical Centre "Dr. D. Mišović – Dedinje", a national centre for COVID-19 treatment in children. First, a cross-sectional study was conducted when participants were recruited for the longitudinal follow-up. The research included all children with proven SARS-CoV-2 infection (N = 127), who were hospitalized in the period from March 6 to May 31, 2020 (the first wave of the pandemic in Serbia). Demographic, clinical and laboratory data were collected from medical records. The quality of life of 81 children was assessed, using the KINDL questionnaire, two years after the recovery from the infection. RESULTS: The average age of the patients was 7.9 ± 5.5 years. Most children (95%) had contact with COVID-19 positive family members. The most common manifestations in paediatric patients with COVID-19 were fever (45.7%), tachycardia (29.1%) and cough (26.8%). Pneumonia was registered in 1/4 of the subjects, neutropenia and lymphocytosis in more than one-half, elevated C-reactive protein (CRP) concentration (> 10 mg/L) in 4%, and liver injury parameters in 20% of patients. Antibiotics were used in 47.2% of participants, mostly azithromycin (37.8%) and ceftriaxone (22.8%). The most important predictors of the antibiotic administration were fever (OR 4.32; 95% CI: 1.77, 10.56; p = 0.001) and radiographic findings of pneumonia (OR 7.42; 95% CI: 2.52, 21.83; p = 0.001). All patients with active chronic disease (N = 4) had pneumonia treated with antibiotics, two children were on supplemental oxygen therapy, and one with a variant Guillain-Barré syndrome required mechanical ventilation. Predictors of the administration of a higher number of antibiotics in children aged 1–5 years were: being a boy (B = -0.65; 95% CI: -1.17, -0.13; p = 0.018), absence of COVID-19 in the family (B = -1.38, 95% CI: -2.43, -0.34; p = 0.011), higher CRP concentration (B = 0.12; 95% CI: 0.07, 0.17; p = 0.001) and radiographically verified pneumonia (B = 0.81; 95% CI: 0.34, 1.29; p = 0.002). These parameters, along with fever (B = 3.20; 95% CI: 1.03, 5.37; p = 0.006), were associated with a longer duration of the antibiotic treatment...