Decreased Clinical Severity of Pediatric Acute COVID-19 and MIS-C and Increase of Incidental Cases during the Omicron Wave in Comparison to the Delta Wave
Abstract
1. Introduction
2. Methods
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Delta | Omicron | p-Value | ||
---|---|---|---|---|
Total admitted (no.) | 84 | 171 | ||
Due to COVID-19 [no. (%)] | 68 (81%) | 116 (66%) | 0.05 | |
Non-respiratory [no. (%)] | 29 (35%) | 49 (28%) | 0.96 | |
Respiratory [no. (%)] | 39 (46%) | 67 (38%) | 0.96 | |
Sex | Female [no. (%)] | 30 (44%) | 55 (47%) | 0.69 |
Male [no. (%)] | 38 (56%) | 61 (53%) | 0.69 | |
Race | White [no. (%)] | 40 (59%) | 62 (53%) | 0.52 |
Black [no. (%)] | 17 (25%) | 28 (24%) | 0.90 | |
Other/Not declared [no. (%)] | 11 (16%) | 30 (26%) | 0.14 | |
Ethnicity | Hispanic [no. (%)] | 4 (6%) | 10 (9%) | 0.50 |
Age | <2 months [no. (%)] | 13 (19%) | 16 (14%) | 0.35 |
0 to 4 [no. (%)] | 31 (46%) | 72 (62%) | 0.048 | |
5 to 11 [no. (%)] | 13 (19%) | 20 (17%) | 0.76 | |
12 to 18 [no. (%)] | 21 (31%) | 20 (17%) | 0.04 | |
19 and above [no. (%)] | 3 (4%) | 4 (3%) | 0.74 | |
Duration of symptoms [Mean no. days (Median no. days)] | 4.6 (3) | 3.7 (2) | 0.16 | |
Non-respiratory [Mean no. days (Median no. days)] | 3.9 (2) | 3.6 (2) | 0.76 | |
Respiratory [Mean no. days (Median no. days)] | 5.1 (4) | 3.7 (2) | 0.09 | |
Length of stay [Mean no. days (Median no. days)] | 3.7 (3) | 2.8 (2) | 0.12 | |
Non-respiratory [Mean no. days (Median no. days)] | 2.6 (2) | 2.2 (1) | 0.64 | |
Respiratory [Mean no. days (Median no. days)] | 4.5 (3) | 3.1 (2) | 0.12 | |
Pressor Use [no. (%)] | 4 (6%) | 5 (4%) | 0.64 | |
Non-respiratory [no. (%)] | 3 (10%) | 2 (4%) | 0.36 | |
Respiratory [no. (%)] | 1 (3%) | 3 (4%) | 1.00 | |
NIPPV Use [no. (%)] | 23 (34%) | 23 (20%) | 0.04 | |
Ventilator Use [no. (%)] | 1 (1%) | 4 (3%) | 0.43 |
Delta | Omicron | |||||
---|---|---|---|---|---|---|
Type of diagnosis | No prior history | Limited history | Complex history | No prior history | Limited history | Complex history |
Incidental [no. (%)] | 9 (56.3%) | 6 (38%) | 1 (6.3%) | 22 (40.0%) | 22 (40%) | 11 (20.0%) |
Non-respiratory COVID-19 [no. (%)] | 9 (30.0%) | 13 (45%) | 7 (23.3%) | 30 (58.8%) | 9 (18%) | 10 (19.6%) |
Respiratory COVID-19 [no. (%)] | 15 (38.5%) | 14 (36%) | 10 (25.6%) | 21 (30.4%) | 21 (31%) | 25 (36.2%) |
Total COVID-19 [no. (%)] | 35 (29.2%) | 27 (40%) | 17 (24.6%) | 51 (42.5%) | 30 (26%) | 35 (29.2%) |
Discharge Diagnosis | Delta | Omicron | p-Value |
---|---|---|---|
Pulmonary: | |||
Lower Respiratory Tract Infection [no. (%)] | 31 (46%) | 44 (38%) | 0.352 |
URTI [no. (%)] | 5 (7%) | 2 (2%) | 0.103 |
Croup [no. (%)] | 2 (3%) | 15 (13%) | 0.032 |
Asthma exacerbation [no. (%)] | 3 (4%) | 7 (6%) | 0.747 |
Apnea [no. (%)] | 0 (0%) | 1 (1%) | 1.000 |
Inflammatory: | |||
Fever [no. (%)] | 6 (9%) | 5 (4%) | 1.000 |
MIS-C [no. (%)] | 2 (3%) | 3 (3%) | 1.000 |
Neonatal Fever/Sepsis Workup [no. (%)] | 6 (9%) | 9 (8%) | 0.787 |
Cardiac: | |||
Cardiac arrest [no. (%)] | 0 (0%) | 2 (2%) | 0.532 |
Myo/pericarditis [no. (%)] | 0 (0%) | 2 (2%) | 0.532 |
Neurologic: | |||
TIA/Stroke [no. (%)] | 1 (1%) | 1 (1%) | 1.000 |
Aseptic meningitis [no. (%)] | 0 (0%) | 1 (1%) | 1.000 |
Seizure, including febrile seizure [no. (%)] | 3 (3%) | 9 (8%) | 0.540 |
Altered mental status [no. (%)] | 1 (1%) | 0 (0%) | 0.370 |
Gastrointestinal: | |||
Gastroenteritis [no. (%)] | 7 (10%) | 18 (16%) | 0.378 |
DKA [no. (%)] | 5 (7%) | 1 (1%) | 0.027 |
Dehydration/FTT [no. (%)] | 5 (7%) | 0 (0%) | 0.006 |
Other: | |||
Inflammatory rash/urticaria [no. (%)] | 1 (1%) | 2 (2%) | 1.000 |
Mucositis [no. (%)] | 0 (0%) | 1 (1%) | 1.000 |
Rhabdomyolysis/myositis [no. (%)] | 2 (3%) | 2 (2%) | 0.627 |
Acute chest crisis (in sickle cell disease) [no. (%)] | 0 (0%) | 3 (3%) | 0.297 |
Vaso-occlusive crisis [no. (%)] | 1 (1%) | 2 (2%) | 1.000 |
Vaginal bleeding [no. (%)] | 0 (0%) | 1 (1%) | 1.000 |
Immune-mediated thrombocytopenia [no. (%)] | 0 (0%) | 1 (1%) | 1.000 |
Chemotherapy complication [no. (%)] | 0 (0%) | 2 (2%) | 0.532 |
Intra-uterine fetal demise [no. (%)] | 1 (1%) | 0 (0%) | 0.370 |
Premature labor [no. (%)] | 1 (1%) | 1 (1%) | 1.000 |
MIS-C Characteristics | Delta (n = 11) | Omicron (n = 10) | p-Value |
---|---|---|---|
Rate per 100,000 diagnosed cases of COVID-19 (Erie County, NY) | 72 | 49 | 0.04 |
Age [years (95% CI)] | 9.0 (2.9) | 9.0 (3.4) | 0.99 |
Female [no. (%)] | 3 (29%) | 4 (40%) | 0.56 |
White [no. (%)] | 4 (33%) | 5 (50%) | 0.56 |
Black [no. (%)] | 5 (42%) | 3 (30%) | 0.50 |
Hispanic [no. (%)] | 0 (0%) | 2 (20%) | 0.13 |
Prior ER visits [no. (%)] | 1 (9%) | 4 (40%) | 0.11 |
Symptom duration [days (95% CI)] | 3.9 (0.8) | 4.1 (0.6) | 0.67 |
Positive SARS-CoV2 PCR [no. (%)] | 2 (17%) | 3 (30%) | 1.00 |
Length of Stay [days (95% CI)] | 6.8 (2.0) | 4.1 (0.7) | 0.02 |
ICU stay [no. (%)] | 10 (83%) | 3 (30%) | 0.01 |
Delta | Omicron | p-Values for Specific Comparator Groups | ||||||
---|---|---|---|---|---|---|---|---|
normal range | Acute COVID-19 | MIS-C | Acute COVID-19 | MIS-C | MISC: Delta vs. Omicron | Delta: COVID-19 vs. MIS-C | Omicron: COVID-19 vs. MIS-C | |
Hemoglobin (g/dL) [mean (95% CI)] | 11.5–14.5 | 13.5 (2.1) | 11.2 (0.7) | 12.1 (2.7) | 11.4 (1.5) | 0.82 | 0.000 | 0.312 |
White blood cell count (×109/L) [mean (95% CI)] [mean (95% CI)] | 4.0–12.0 | 9.8 (6.4) | 10.6 (3.1) | 10.1 (5.2) | 11.5 (2.5) | 0.62 | 0.660 | 0.305 |
Red blood cell count (1012/L) [mean (95% CI)] [mean (95% CI)] | 4.0–5.3 | 4.8 (1.2) | 4.2 (0.3) | 4.5 (1.3) | 4.2 (0.6) | 0.97 | 0.009 | 0.351 |
Hematocrit [mean (95% CI)] | 33.0–43.0 | 39.3 (7.7) | 34.0 (2.4) | 40.6 (32.8) | 33.9 (4.5) | 0.99 | 0.001 | 0.084 |
Neutrophil (count, ×109/L) [mean (95% CI)] [mean (95% CI)] | 1.5–6.6 | 6.8 (6.7) | 8.6 (2.8) | 5.9 (4.3) | 8.7 (2.1) | 0.95 | 0.267 | 0.015 |
Lymphocyte (count, ×109/L) [mean (95% CI)] | 1.0–5.5 | 2.5 (2.0) | 1.1 (0.2) | 3.0 (2.7) | 2.3 (2.2) | 0.18 | 0.000 | 0.479 |
Basophil (count, x109/L) [mean (95% CI)] | <0.1 | 0.1 (0.7) | 0.0 (0.0) | 0.0 (0.0) | 0.0 (0.0) | 0.89 | 0.298 | 0.831 |
Eosinophil (count, ×109/L) [mean (95% CI)] | <0.7 | 0.0 (0.1) | 0.2 (0.2) | 0.2 (0.8) | 0.2 (0.1) | 0.91 | 0.158 | 0.879 |
Monocytes (count, ×109/L) [mean (95% CI)] | <1.0 | 0.9 (0.9) | 0.4 (0.1) | 0.9 (0.6) | 0.8 (0.6) | 0.17 | 0.000 | 0.706 |
Platelet (count, ×109/L) [mean (95% CI)] | 150–450 | 268.9 (112.3) | 160.0 (38.3) | 287.4 (130.7) | 186.3 (67.7) | 0.46 | 0.000 | 0.009 |
C-reactive protein (mg/L) [mean (95% CI)] | 0.2–10.0 | 34.0 (41.0) | 188.5 (53.6) | 53.7 (97.3) | 170.1 (169.4) | 0.81 | 0.000 | 0.152 |
Erythrocyte sedimentation rate (mm/hr) [mean (95% CI)] | 0–12 | 17.3 (17.2) | 56.1 (20.0) | 24.8 (24.5) | 44.5 (22.9) | 0.40 | 0.004 | 0.109 |
Lactate dehydrogenase (U/L) [mean (95% CI)] | 155–345 | 560.8 (368.6) | 451.6 (100.1) | 891.5 (1988.8) | 289.1 (47.1) | 0.009 | 0.425 | 0.297 |
Ferritin (ug/L) [mean (95% CI)] | 7–140 | 575.4 (1003.4) | 1442.4 (1031.3) | 923.9 (4744.3) | 1056.1 (1007.0) | 0.56 | 0.120 | 0.917 |
Albumin (g/dL) [mean (95% CI)] | 3.5–5.0 | 3.9 (0.6) | 3.5 (0.3) | 4.7 (4.8) | 3.8 (0.3) | 0.13 | 0.041 | 0.171 |
Protein (g/dL) [mean (95% CI)] | 4.8–7.8 | 6.7 (0.9) | 6.5 (0.7) | 6.8 (0.8) | 6.7 (0.8) | 0.76 | 0.594 | 0.714 |
Alanine Aminotransferase (u/L) [mean (95% CI)] | 5–50 | 52.0 (92.8) | 53.0 (31.6) | 68.7 (304.4) | 27.7 (11.2) | 0.13 | 0.961 | 0.299 |
Aspartate Aminotransferase (U/L) [mean (95% CI)] | 5–50 | 72.1 (119.7) | 74.0 (42.6) | 129.2 (479.5) | 43.9 (30.6) | 0.23 | 0.943 | 0.182 |
Alkaline Phosphatase (U/L) [mean (95% CI)] | 80–345 | 167.8 (86.6) | 164.7 (35.4) | 205.7 (237.8) | 166.3 (36.9) | 0.94 | 0.884 | 0.271 |
Total bilirubin (mg/dL) [mean (95% CI)] | 0.2–1.2 | 0.7 (1.0) | 1.3 (1.1) | 1.3 (3.2) | 1.5 (0.7) | 0.82 | 0.264 | 0.811 |
Sodium (mmol/L) [mean (95% CI)] | 135–145 | 137.8 (3.4) | 132.7 (2.0) | 137.2 (4.2) | 132.9 (2.0) | 0.88 | 0.000 | 0.001 |
Potassium (mmol/L) [mean (95% CI)] | 3.5–5.0 | 4.6 (0.8) | 3.9 (0.5) | 4.6 (0.8) | 3.8 (0.2) | 0.72 | 0.025 | 0.000 |
Chloride (mmol/L) [mean (95% CI)] | 96–110 | 105.5 (4.3) | 101.7 (3.0) | 104.4 (4.2) | 99.4 (4.2) | 0.34 | 0.029 | 0.026 |
Bicarbonate (mmol/L) [mean (95% CI)] | 20–30 | 18.8 (4.6) | 16.8 (2.2) | 19.5 (4.3) | 28.4 (17.3) | 0.17 | 0.116 | 0.273 |
Blood urea nitrogen (mg/dL) [mean (95% CI)] | 5–19 | 10.9 (4.3) | 14.0 (6.4) | 12.0 (11.4) | 15.2 (5.0) | 0.75 | 0.328 | 0.231 |
Serum creatinine (mg/dL) [mean (95% CI)] | 0.4–1.0 | 0.7 (0.3) | 0.7 (0.2) | 0.7 (0.9) | 0.7 (0.1) | 0.85 | 0.672 | 0.928 |
Institutional normalized ratio [mean (95% CI)] | N/A | 1.1 (0.2) | 1.4 (0.1) | 1.2 (0.2) | 1.3 (0.2) | 0.13 | 0.000 | 0.119 |
Prothrombin time (seconds) [mean (95% CI)] | 11.0–15.0 | 13.9 (1.6) | 17.2 (1.2) | 14.7 (1.8) | 15.8 (1.5) | 0.14 | 0.000 | 0.113 |
Partial thromboplastin time (seconds) [mean (95% CI)] | 25.0–34.0 | 31.2 (4.7) | 39.4 (9.0) | 32.7 (6.5) | 38.5 (3.1) | 0.84 | 0.088 | 0.001 |
D-dimer (mcg/mL) [mean (95% CI)] | 0.00–0.45 | 2.0 (3.3) | 3.5 (1.6) | 2.7 (5.1) | 2.6 (1.3) | 0.33 | 0.125 | 0.818 |
Fibrinogen (g/L) [mean (95% CI)] | 200–470 | 377.3 (109.4) | 626.6 (98.9) | 420.5 (178.5) | 608.8 (341.4) | 0.90 | 0.001 | 0.222 |
Troponin-I (ug/L) [mean (95% CI)] | 0.00–0.06 | 0.01 (0) | 0.74 (0.82) | 0.1 (0.1) | 0.04 (0.04) | 0.14 | 0.126 | 0.680 |
Brain natriuretic peptide (ng/L) [mean (95% CI)] | 0–99 | 41.8 (50.8) | 438.6 (274.9) | 470.2 (1249.5) | 85.9 (109.5) | 0.011 | 0.004 | 0.227 |
Procalcitonin (mcg/L) [mean (95% CI)] | 0.02–0.09 | 0.4 (0.8) | 8.8 (10.3) | 2.5 (11.9) | 4.4 (2.7) | 0.14 | 0.032 | 0.367 |
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Kenney, P.O.; Chang, A.J.; Krabill, L.; Hicar, M.D. Decreased Clinical Severity of Pediatric Acute COVID-19 and MIS-C and Increase of Incidental Cases during the Omicron Wave in Comparison to the Delta Wave. Viruses 2023, 15, 180. https://doi.org/10.3390/v15010180
Kenney PO, Chang AJ, Krabill L, Hicar MD. Decreased Clinical Severity of Pediatric Acute COVID-19 and MIS-C and Increase of Incidental Cases during the Omicron Wave in Comparison to the Delta Wave. Viruses. 2023; 15(1):180. https://doi.org/10.3390/v15010180
Chicago/Turabian StyleKenney, Patrick O., Arthur J. Chang, Lorna Krabill, and Mark D. Hicar. 2023. "Decreased Clinical Severity of Pediatric Acute COVID-19 and MIS-C and Increase of Incidental Cases during the Omicron Wave in Comparison to the Delta Wave" Viruses 15, no. 1: 180. https://doi.org/10.3390/v15010180
APA StyleKenney, P. O., Chang, A. J., Krabill, L., & Hicar, M. D. (2023). Decreased Clinical Severity of Pediatric Acute COVID-19 and MIS-C and Increase of Incidental Cases during the Omicron Wave in Comparison to the Delta Wave. Viruses, 15(1), 180. https://doi.org/10.3390/v15010180