308 - Associations between characteristics of pediatric inpatients with COVID-19, abnormal hepatic indices, and need for intensive care

Poster Number: 308
Publication Number: 308.213

Jenna Berson, New York University Grossman School of Medicine, New York, NY, United States; Jennifer Moody, Children's National Health System, Washington, DC, United States; Asif Noor, The Children’s Medical Center at NYU Winthrop Hospital, Mineola, NY, United States; Christopher Daviess, Weill Cornell Medicine, Brooklyn, NY, United States; Jonathan S. Farkas, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Sourabh Verma, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Alexander F. Glick, NYU Grossman School of Medicine, New York, NY, United States

Background: Children with Acute Coronavirus disease 2019 (COVID-19) are known to present with gastrointestinal (GI) symptoms. The spectrum of hepatic injury in hospitalized pediatric patients is less understood.

Objective: Among hospitalized children and young adults with a positive (severe acute respiratory syndrome coronavirus 2 test (SARS-CoV-2+), examine 1) whether patient characteristics and presenting GI symptoms are associated with abnormal hepatic indices (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and albumin) and 2) whether hepatic index abnormalities are associated with intensive care unit (ICU) admission.

Design/Methods: This was a retrospective cohort study of SARS-CoV-2+ patients (n = 224) admitted to the pediatric acute care unit or ICU at 1 of 4 hospitals in the New York metropolitan area; we excluded patients with MIS-C. Presenting GI symptoms, patient characteristics, hepatic indices, and disposition (acute care unit or ICU) were extracted manually. Aim 1 predictors included patient characteristics (sex, age, race/ethnicity, presence of comorbidity) and presenting GI (vomiting, diarrhea, abdominal pain) symptoms; outcomes were abnormal hepatic indices (AST, ALT, albumin) (using age-defined cutoffs). Aim 2 predictors were abnormal hepatic indices; outcome variable was ICU admission. Data were analyzed using Fisher Exact/Chi Square Tests. Associations between abnormal hepatic indices and ICU admission were examined using logistic regression (adjusting for patient characteristics).

Results: Characteristics associated with abnormal hepatic indices included patient age, gender, and presence of comorbidity (Table 1). Patients with diarrhea were more likely to have abnormal ALT (38.1 vs. 20.6%, P=0.03) and albumin (14.3 vs. 4.4%, P=0.04). Presence of abdominal pain was associated with abnormal ALT. In bivariate analysis, age, race/ethnicity, presence of a comorbidity, and abnormal hepatic indices (AST, ALT, and albumin) were associated with ICU admission (Table 2). In adjusted analyses, ICU admission was more likely for patients with abnormal ALT (adjusted odds ratio [AOR] 3.7, 95% confidence interval [CI] 1.3-10.5, P=0.02) and albumin (AOR 11.7, 95% CI 1.6-87.2, P=0.02) but not abnormal AST (Table 3).Conclusion(s): Hospitalized SARS-CoV-2+ children and young adults were more likely to have abnormal hepatic indices if they were male, had comorbidities, and presented with diarrhea or abdominal pain. Abnormal hepatic indices were associated with the need for ICU admission. More studies are needed to explore further implications of hepatic injury in children with COVID-19.
Jenna Berson CVBerson, MD CV (1)-converted.pdf
Table 2