Comparison of inflammatory markers, coagulation indicators and outcomes between influenza and COVID-19 infection amongst children: A systematic review and meta-analysis

Yutang Yang; Qi Zheng; Linlin Yang; Lei Wu

doi:10.1016/j.heliyon.2024.e30391

Comparison of inflammatory markers, coagulation indicators and outcomes between influenza and COVID-19 infection amongst children: A systematic review and meta-analysis

Heliyon. 2024 May 1;10(10):e30391. doi: 10.1016/j.heliyon.2024.e30391. eCollection 2024 May 30.

Authors

Yutang Yang¹, Qi Zheng², Linlin Yang³, Lei Wu⁴

Affiliations

¹ Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, 250021, China.
² Department of Gynecology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, 250013, China.
³ Department of Hematology and Rheumatology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, 250013, China.
⁴ Department of Pediatrics, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, 250013, China.

Abstract

Background: Influenza and COVID-19 patients share similar features and outcomes amongst adults. However, the difference between these diseases is not explored in paediatric age group especially in terms of inflammatory markers, coagulation profile and outcomes. Hence, we did this review to compare the inflammatory, coagulation features and outcomes between influenza and COVID-19 infected children.

Methods: Literature search was done in PubMed Central, Scopus, EMBASE, CINAHL, Cochrane library, Google Scholar & ScienceDirect from November 2019 to May 2022. Risk of bias assessment was done through Newcastle Ottawa scale. Meta-analysis was done using random-effects model and the final pooled estimate was reported as pooled odds ratio (OR) or standardized mean difference (SMD) along with 95 % confidence interval (CI) depending on the type of outcome.

Results: About 16 studies were included with most studies having higher risk of bias. Influenza paediatric patients had significantly higher erythrocyte sedimentation rate (ESR) (pooled SMD = 0.60; 95%CI: 0.30-0.91; I² = 0 %), lactate dehydrogenase (LDH) (pooled SMD = 2.01; 95%CI: 0.37-3.66; I² = 98.4 %) and prothrombin time (PT) (pooled SMD = 2.12; 95%CI: 0.44-3.80; I² = 98.3 %) when compared to paediatric COVID-19 patients. There was no significant difference in terms of features like CRP, procalcitonin, serum albumin, aPTT, mortality and need for mechanical ventilation.

Conclusion: Inflammatory markers like ESR, LDH and PT was significantly higher in influenza patients when compared to COVID-19 in children, while rest of the markers and adverse clinical outcomes were similar between both the groups. Identification of these biomarkers has helped in understanding the distinctness of COVID-19 and influenza virus and develop better management strategies.

Keywords: COVID-19; Influenza; Meta-analysis; SARS-CoV-2.